Articles and Blogs

NATIONAL Azar Issues 2nd HIPAA Privacy Rule Waiver in As Many Months Aetna Reaches Settlements with State AGs Over HIPAA Violations CMS signs up 1,547 providers for new bundled payment model Amazon, Walmart patents highlight potential of biometric monitoring Grassley calls for Federal Trade Commission to examine hospital, insurer contracting 39 new ASCs were opened…Read More

On October 15, 2018, the Department of Health and Human Services (“HHS”), Office for Civil Rights (“OCR”) announced that it had reached a record $16 million settlement with Anthem arising out of alleged violations of the Privacy and Security Rules under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”). The settlement comes after…Read More

The Eleventh Circuit recently held that a qui tam relator cannot intervene in criminal forfeiture proceedings when the Government chooses to criminally prosecute fraud rather than intervene in a qui tam action. In United States v. Couch,[1] a former employee (“Relator”) of a pain management clinic in Alabama tried to recover amounts she believed were…Read More

In September 2018, HHS Office of Inspector General (“OIG”) issued audit Report No. A-01-15-00500 (the “Report”) finding that out of 220 randomly sampled inpatient rehabilitation facility (“IRF”) stays from 2013, nearly 80 percent did not meet Medicare coverage and documentation requirements. Specifically, for 175 of the 220 sampled stays at 135 IRFs, the medical record documentation…Read More

Recently, the Wisconsin Supreme Court affirmatively ruled that an employee’s violation of his or her employer’s written absenteeism policy constituted “misconduct” under Wis. Stat. § 108.04(5), even where the employer’s absenteeism policy was more stringent than the definition of absenteeism outlined under the statute. In doing so, the Court reversed a decision by the Wisconsin…Read More

NATIONAL Healthcare job growth continues; hospitals add 12K positions in September 12 recent hospital, health system outlook and credit rating actions MGMA18: Physicians frustrated over lack of advanced APMs Want your medical records? Better be prepared to call—and pay up Hospitals and physician groups take on risk in BPCI Advanced model 10 informative Q&As with…Read More

To be paid by Medicare, Organ Procurement Organizations (OPOs) and transplant centers must be members of the United Network for Organ Sharing (UNOS), which manages the Organ Procurement and Transplantation Network (OPTN). Transplant centers and OPOs must comply with multiple oversight agencies and requirements, including OPTN policies and guidelines and the Medicare Conditions of Participation…Read More

NATIONAL Verma puts Medicaid insurers on notice, says CMS will begin ‘targeted audits’ While surgery centers support CMS payment proposal, hospital groups submit harsh criticism Supreme Court to hear DSH payments case Banner Health, Ascension executives join hundreds of hospital CEOs defending 340B program MGMA shares physician practice keys to success MGMA18: Underwhelming MIPS payments…Read More

On September 17, 2018, the U.S. Department of Justice (“DOJ”) approved the $52 billion vertical merger between health insurer Cigna Corp. (“Cigna”) and pharmacy benefit manager (“PBM”) Express Scripts. The Cigna-Express Scripts merger is just one in a string of recent health insurer/PBM acquisitions. For more on these transactions, click here. As the largest unaffiliated PBM…Read More

They’re at it again! On August 28, 2018, the Department of Labor’s Wage and Hour Division issued six opinion letters. This was the second batch of opinion letters from the Wage and Hour Division in a matter of months. The Wage and Hour Division, which hadn’t published new opinion letters since 2010, previously issued three…Read More