Articles and Blogs

On May 1, 2017, the United States Court of Appeals released an important decision interpreting the False Claim Act’s (“FCA’s”) materiality requirement in light of the Supreme Court’s 2016 decision in Universal Health Services Inc. v. United States ex rel. Escobar. The case, United States ex rel. Petratos v. Genentech, revolved around allegations regarding the cancer…Read More

Title VII of the of the 21st Century Cures Act (the “Act”) underscores the importance of evidence-based programs and practices for diagnosing, preventing, treating and recovering from mental and substance use disorders. Title VII amends the Public Health Service Act to ensure that such programs reflect the increased knowledge obtained through the progress in science…Read More

If HIPAA covered entities thought the increased rate of enforcement actions at the beginning of 2017 by the Department of Health and Human Services (“HHS”) Office for Civil Rights (“OCR”) was an anomaly, a flurry of settlement announcements by OCR in April indicate the trend may continue. The three recent enforcement actions discussed below demonstrate…Read More

In a decision released May 4, 2017, the Wisconsin Supreme Court held that personal injury attorneys obtaining medical records on behalf of their clients are exempt from statutory certification and retrieval fees (Moya v. Healthport Technologies, LLC, 2017 WI 45, ¶ 2.). The plaintiff was involved in a motor vehicle accident and retained counsel to…Read More

AHCA Passes the House On May 4, the American Health Care Act (“AHCA”) passed the House of Representatives by a vote of 217 to 213. The bill now moves to the Senate where lawmakers have already indicated that they intend to write their own bill instead of taking up what passed in the House. The…Read More

Wisconsin Physician Services, Inc. (“WPS”), the Medicare Administrative Contractor (“MAC”) for J5 (Iowa, Kansas, Missouri and Nebraska) and J8 (Indiana and Michigan) recently issued a local coverage determination (“LCD”), LCD (L36839), revising accreditation requirements for polysomnography and other sleep studies. Historically, the LCD stated that a hospital could use The Joint Commission (“TJC”) accreditation to…Read More

In the March 14, 2017 Federal Register, the Food and Drug Administration (“FDA”) announced that it is considering establishing a new Office of Patient Affairs (“Office”). This consideration results from FDA’s intention to “enhance future patient engagement by providing a more transparent, accessible, and robust experience for patient communities.”1 The Federal Register notice outlined FDA’s…Read More

House Delays AHCA Vote On April 27, House leadership delayed a vote on the American Health Care Act (“AHCA”) until at least next week. As of last night, at least 15 House Republicans remain opposed with another 20 undecided. Without Democratic support, House Republicans can only lose 22 votes. Earlier in the week, a number…Read More

On April 14, 2017, the Centers for Medicare & Medicaid Services (“CMS”) issued a proposed rule addressing several potential changes to the health care delivery system, including physician-owned hospitals (“Proposed Rule”). As a part of this Proposed Rule, CMS is also seeking comment regarding the current restrictions on physician-owned hospitals and how these restrictions affect the…Read More

CMS issued a survey and certification letter, dated April 16, 2017, announcing their intention to publish proposed changes on April 28, 2017 that will require accreditation organizations (“AOs”) (i.e., TJC, DNV, HFAP and CIHQ) to post provider/supplier survey reports and plans of corrections from CMS-approved accreditation programs on their website. CMS is also proposing to…Read More