As part of its recent budget bill, Congress passed a two-year delay in the so-called Cadillac Tax, which was originally
Federal Healthcare Fraud Prevention and Enforcement Efforts Remain in High Gear
June 30, 2015 David Dirr
The federal government’s fraud prevention and enforcement efforts recovered $3.3 billion in federal healthcare funds from individuals and companies according
Hospitals Must Make Charges Public Under Proposed Rule
May 22, 2014 David Dirr
On April 30, 2014, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule under which hospitals must
Release of Medicare Payment Data Could Lead to More Lawsuits
May 15, 2014 David Dirr
On April 9, 2014, the Centers for Medicare and Medicaid Services (CMS) released data showing Medicare payments to physicians in
Fourth Circuit Court Allows Reduction of False Claims Act Penalties
April 21, 2014 David Dirr
As False Claims Act cases have grown prevalent, especially cases alleging violations of the Anti-Kickback Statute or Stark law by
$2.2 Billion J&J Settlement Latest in Big Whistleblower Cases
November 15, 2013 David Dirr
Johnson & Johnson will pay more than $2.2 billion to settle a lawsuit alleging that it marketed off-label uses of its antipsychotic and anti-seizure drugs and that it paid kickbacks to doctors and pharmacists who prescribed the drugs.
Supreme Court Reaffirms Broad Discretion to Arbitrators
June 20, 2013 David Dirr
The U.S. Supreme Court has issued yet another opinion affirming that arbitrators have wide discretion to decide disputes when parties enter into arbitration agreements in advance.
Supreme Court Case Could Alter Ohio Medicaid Lien Law
March 13, 2013 David Dirr
A decision this spring in U.S. Supreme Court case of Delia v. E.M.A. could affect how Ohio and other states recoup their Medicaid costs from the recoveries of Medicaid beneficiaries in tort litigation.
How Smart is the SMART Act?
February 14, 2013 David Dirr
In January 2013, Congress passed the Strengthening Medicare and Repaying Taxpayers Act (“SMART Act”), which amends the Medicare Secondary Payer Act (“MSP Act”). The purpose of the SMART Act is to clarify and simplify portions of the MSP Act. The SMART Act applies to non-group health plans such as workers’ compensation and liability insurance including self-insurance.
HIPAA Settlement Meant to Be a Warning to Smaller Providers
January 14, 2013 David Dirr
On January 2, 2013, the U.S. Department of Health and Human Services (HHS) announced its first settlement involving a breach of protected health information (PHI) affecting fewer than 500 individuals. Under the terms of the settlement, Hospice of North Idaho (HONI) has agreed to pay HHS $50,000 to resolve potential violations of the HIPAA Privacy Rule.
New Healthcare Taxes for the New Year
December 11, 2012 David Dirr
The Affordable Care Act will bring some tax increases on high-income earners in 2013. Starting on January 1st, workers will have to pay an additional Medicare tax of 0.9% on any wages over $200,000, and married couples filing jointly will have to do the same for wages over $250,000
DOJ Sets Another Record in Healthcare Fraud Recoveries
December 6, 2012 David Dirr
The United States Department of Justice (DOJ) again broke a record by recovering approximately $3 billion under the False Claims Act in healthcare fraud and abuse cases in the 2012 fiscal year.
Two Methods for De-Identifying Protected Health Information Under HIPAA
November 30, 2012 David Dirr
On November 26, 2012, the Department of Health and Human Services Office for Civil Rights (OCR) released guidance on how covered entities can de-identify protected health information (PHI) under HIPAA. De-identifying PHI is the process of removing data from health records that could link the PHI with individual patients. If a covered entity de-identifies PHI, it can then use or disclose the data without any HIPAA concerns.
Class-Action Settlement Will Change Medicare Rules
October 26, 2012 David Dirr
A proposed settlement of a national class-action lawsuit should make it easier for people with chronic conditions and disabilities to qualify for Medicare coverage for home healthcare services, skilled nursing care, and therapy.
Changes Coming for Medicare Set-Aside Arrangements
August 30, 2012 David Dirr
The law governing Medicare Set-Aside Arrangements (“MSAs”) in personal injury liability lawsuits may soon be changing. In personal injury liability cases, MSAs are funds from a judgment or settlement allocated to cover the future medical expenses of a Medicare beneficiary.
Malpractice Lawsuits are Lengthy, but Physicians Often Prevail
June 7, 2012 David Dirr
In a study released in May 2012, researchers found that physicians successfully defended most of the medical malpractice lawsuits against them. Researchers examined more than 10,000 malpractice claims across the United States from 2002 to 2005. Of those claims, about 55% resulted in a lawsuit.
HIPAA Settlement a Warning to Others
March 22, 2012 David Dirr
The U.S. Department of Health and Human Services (HHS) hopes that its recent settlement of $1.5 million with Blue Cross and Blue Shield of Tennessee serves as a warning to healthcare providers and insurers.
$2.4 Billion Recovered Under False Claims Act in 2011
January 19, 2012 David Dirr
It was another record-setting year at the Department of Justice (DOJ) for the prosecution of healthcare fraud. The DOJ recovered over $2.4 billion in civil cases of healthcare fraud in fiscal year 2011 under the False Claims Act. The majority of the $2.4 billion recovered was the result of whistleblower or qui tam actions.
Proposed Rule Requires Labs to Send Test Results to Patients
December 27, 2011 David Dirr
The Department of Health and Human Services (HHS) has published a proposed rule that would modify both the HIPAA Privacy Rule and the Clinical Laboratory Improvement Amendments of 1988 (CLIA) to allow laboratories to send test results directly to patients.
Lawsuit Challenges Method Used to Determine Medicare Rates
December 8, 2011 David Dirr
A group of primary care physicians from Georgia have alleged in a federal lawsuit that the Centers for Medicare and Medicaid Services (CMS) violates federal law by relying on the advice of a committee of the American Medical Association (AMA) in setting Medicare rates for physician services. Since 1991, the Relative Value Scale Update Committee (RUC) of the AMA has proposed Medicare rates for approximately 7,000 medical procedures to CMS.
Hospitals See Medicare Payments Increase Under Final Rule
December 2, 2011 David Dirr
General acute care hospitals were relieved to learn that under the Fiscal Year 2012 Inpatient Prospective Payment System (IPPS) Final Rule, they will see an increase in payments by 1% in fiscal year 2012 rather than the .5% decrease that CMS originally proposed. The 1% increase will result in an additional $1.13 billion in payments compared to fiscal year 2011. The one percent net increase was due to the adoption of a higher market basket of 3%, a lower multifactor productivity adjustment of 1% versus 1.2%, and a smaller coding adjustment of 2% rather than 3.15%.
New Legal Waivers for ACOs
November 15, 2011 David Dirr
In the spring of this year, the Centers for Medicare and Medicaid Services (CMS) released the proposed rules governing Accountable Care Organizations (ACOs) participating in the CMS Shared Savings Program. Under the Shared Savings Program, if an ACO is able to reduce the cost of caring for Medicare patients without compromising quality, it will be entitled to split the savings with CMS.
Ohio Supreme Court Upholds Insurance Policy Limitation of Action Clauses
October 21, 2011 David Dirr
In two recent cases, the Supreme Court of Ohio upheld limitation of action clauses in two insurance policies. Limitation of action clauses narrow the timeframe, which is 15 years by statute in Ohio, in which an insured may sue to enforce a policy.
Supreme Court Could End Medicaid Appeals
September 29, 2011 David Dirr
Next week, the Supreme Court of the United States will hear oral arguments in a case that could eliminate the ability of providers and Medicaid beneficiaries to challenge state Medicaid rates in federal courts.
Many Say No to Proposed ACOs
August 5, 2011 David Dirr
The Centers for Medicare and Medicaid Services (CMS) released the much-anticipated proposed regulations governing Accountable Care Organizations (ACOs) on March 31, 2011, and so far their reception by the healthcare industry has been decidedly negative.
