In April, the United States Supreme Court conducted oral arguments on a key provision of the Patient Protection and Affordable Care Act (“ACA”) that may impact up to 8 million policy holders.  The case, King v. Burwell, presents the issue as to whether the law makes people in all 50 states eligible for federal tax Read More 

In a traditional medical negligence action, plaintiffs often seek the production of various peer review files, incident reports and other similar documents related to patient safety and quality improvement.  Although Congress has enacted a statutory mandate exempting such documents from discovery if the provider complies with the Patient Safety Quality Improvement Act (PSQIA) provisions, a Read More 

In May, the U.S. Department of Health and Human Services (“HHS”) Office of Inspector General (“OIG”) published proposed rules amending the Civil Monetary Penalty (“CMP”) rules. Generally, the CMP rules allow the OIG to impose monetary penalties on healthcare providers and/or exclude providers from the federal healthcare programs for engaging in certain conduct. For example, Read More 

In May, the U.S. Department of Health and Human Services (“HHS”) Office of Inspector General (“OIG”) published proposed rules amending the Civil Monetary Penalty (“CMP”) rules. Generally, the CMP rules allow the OIG to impose monetary penalties on healthcare providers and/or exclude providers from the federal healthcare programs for engaging in certain conduct. For example, Read More 

Traditionally, the obligations of a business associate to comply with the Privacy and Security Rules promulgated under the Health Insurance Portability and Accountability Act (“HIPAA”) were the result of contractual obligations contained in an agreement between the business associate and a covered entity (health plans, health care clearing house, and health care provider who transmits Read More 

Traditionally, the obligations of a business associate to comply with the Privacy and Security Rules promulgated under the Health Insurance Portability and Accountability Act (“HIPAA”) were the result of contractual obligations contained in an agreement between the business associate and a covered entity (health plans, health care clearing house, and health care provider who transmits Read More 

In May, the Centers for Medicare & Medicaid Services (“CMS”) published a proposed rule that grants healthcare providers greater flexibility and a longer timeline for complying with the electronic health record (“EHR”) meaningful use requirements as set forth in the Health Information Technology for Economic and Clinical Health (“HITECH”) Act. At the end of August, Read More 

Maximum damages in the second half of the False Claims Act (“FCA”) lawsuit against Halifax Hospital Medical Center and Halifx Staffing, Inc. (“Halifax”) could have exceeded $200 million. But last month, Halifax settled with Elin Baklid-Kunz, the whistleblower and Halifax’s former compliance director, for $1 million. This settlement is the result of a ruling by Read More 

On July 11, 2014, the Center for Medicare and Medicaid Services (“CMS”) published its proposed annual update to the Medicare physician fee schedule. The proposed fee schedule implements changes required by the Patient Protection and Affordable Care, updates the relative value units (RVUs), and makes other adjustments to the services for which Medicare will reimburse Read More 

On July 11, 2014, the Center for Medicare and Medicaid Services (“CMS”) published its proposed annual update to the Medicare physician fee schedule. The proposed fee schedule implements changes required by the Patient Protection and Affordable Care, updates the relative value units (RVUs), and makes other adjustments to the services for which Medicare will reimburse Read More 

The U.S. Department of Health and Human Services’ Office of Inspector General (“OIG”) recently announced a determination that the University of Cincinnati Medical Center owed more than $9.8 million in Medicare repayments. OIG’s determination was based on an audit it conducted using extrapolation. OIG audited 228 claims and determined that 56% of the claims had Read More 

In October 2013, the Center for Medicare and Medicaid Services (“CMS”) implemented a new reimbursement rule that only patients admitted for at least two nights will qualify for inpatient care and reimbursement. According to CMS, physicians should admit patients that “require two or more midnights of hospital services, and should treat most other beneficiaries on Read More 

In October 2013, the Center for Medicare and Medicaid Services (“CMS”) implemented a new reimbursement rule that only patients admitted for at least two nights will qualify for inpatient care and reimbursement. According to CMS, physicians should admit patients that “require two or more midnights of hospital services, and should treat most other beneficiaries on Read More 

The Center for Medicare & Medicaid Services (“CMS”) recently proposed a rule amending the implementation timeline for “meaningful use” of electronic health records (“EHR”) and granting providers flexibility in complying with the 2014 requirements. The Medicare and Medicaid EHR Incentive Program offers financial incentives to providers who achieve certain benchmarks and show they are achieving Read More 

On May 28, 2014, King’s Daughters Medical Center in Ashland, Kentucky, entered into a civil settlement with the Federal government and the Commonwealth of Kentucky in the amount of $40.9 million. This represents the largest health care fraud settlement involving a hospital in the history of the Eastern District of Kentucky. King’s Daughters entered into Read More 

In February 2012, Concentra Health Service, a subsidiary of Humana, reported a privacy breach involving the protected health information of 148 individuals resulting from the theft an unencrypted laptop from the car of an employee. Upon investigation, the OCR determined that Concentra had conducted multiple risk analyses that identified a lack of encryption on its Read More