01/25/2013 - HHS Provides Amendments to HIPAA Privacy and Security Regulations to Conform Regulations to HITECH, GINA and Add Some Additional Changes
The long awaited Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Regulation amendments (the “Changes”) to incorporate the changes made by Health Information Technology for Economic and Clinical Health (HITECH) in 2009 as part of the American Recovery and Reinvestment Act and by the Genetic Information Nondiscrimination Act (“GINA”) were recently released.
03/22/2012 - The Antitrust Implications of Health Care Reform
The current hot topic among health care providers is whether to join an accountable care organization (“ACO”). With this interest in consolidation comes the latest round of antitrust scrutiny.
11/29/2011 - State Medicaid RAC Audits to Begin in 2012
Medicaid providers will be subject to new audits by Medicaid Recovery Audit Contractors (RACs), beginning in January 2012. These new audits will be in addition to existing audits being conducted by Medicare RACs, Medicaid Integrity Contractors (MICs) and Zone Program Integrity Contractors (ZPICs), among others.
09/21/2011 - CMS and OIG Respond to Senate Inquiry on Physician-Owned Distributorships
The Centers for Medicare & Medicaid Services (CMS) and the Office of Inspector General (OIG) for the U.S. Department of Health & Human Services (HHS) have responded to the U.S. Senate’s request for information on physician-owned distributorships (PODs).
07/21/2011 - Armor Holdings, Inc., Settles Foreign Corrupt Practices Act Claims with SEC, DOJ
Armor Holdings, Inc., recently resolved allegations that it violated both the anti-bribery and accounting provisions of the Foreign Corrupt Practices Act. Because of Armor’s extensive cooperation with the government, it was able to obtain a non-prosecution agreement from the Department of Justice and a settlement from the Securities and Exchange Commission.
05/19/2011 - Will Pioneer ACOs Come to the Rescue, or is the Government Rearranging Deck Chairs on the Titanic?
The Centers for Medicare and Medicaid Services (CMS) announced the creation of so-called “Pioneer ACOs” on May 17 in an attempt to blunt heavy criticism over the draft regulations on Accountable Care Organizations (ACOs) issued on March 31, 2011 (the “Draft Regulations”). The Draft Regulations have been criticized due to their burdensome data collection requirements, large start-up costs, uncertain savings, possible losses and troublesome governance mandates.
05/13/2011 - FTC Orders Texas Doctors' Group to Cease Joint Price Negotiations with Insurers
Southwest Health Alliance (“Southwest”), an independent practice association with approximately 900 member-physicians, has agreed to a proposed order recently entered by the Federal Trade Commission (“FTC”) settling charges that it engaged in anticompetitive conduct in its dealings with insurers and other payors for the provision of physician services (collectively, “insurers” or “payors”).
04/20/2011 - Medicare EHR Incentive Program Starts Attestation Phase: Physicians and Hospitals to Share $27 Billion Beginning May 2011
On April 18, 2011, the Centers for Medicare and Medicaid Services (CMS) began the attestation phase under its $27 billion Medicare EHR Incentive Program. Incentive payments for the meaningful use of electronic health records (EHR) will begin in May 2011 and will continue over the next several years.
04/04/2011 - ACOs Face Large Start-Up Costs, Uncertain Savings and Possible Losses Under Proposed Rules from CMS
Accountable Care Organizations (ACOs) will face large start-up costs under proposed rules issued on March 31, 2011 by the Centers for Medicare and Medicaid Services (CMS), with an uncertain outlook for savings and even possible losses.
03/15/2011 - Office for Civil Rights Announces Fines for Violations of HIPAA Privacy Rule
The Office for Civil Rights (OCR) of the U.S. Department of Health and Human Services has recently announced two significant enforcement actions against health care providers for violating the HIPAA Privacy Rule.
12/21/2009 - Spirit of Cooperation
The Texas Supreme Court has called for cooperation between parties in e-discovery: “A fundamental tenet of our discovery rules is cooperation between parties and their counsel, and the expectation that agreements will be made as reasonably necessary for efficient disposition of the case.”
06/03/2009 - Medicare's Recovery Audit Contractor Program: RAC Reviews and Appeals
In order to ensure accurate payments under the Medicare fee-for-service program, the Centers for Medicare & Medicaid Services (“CMS”) has implemented the Recovery Audit Contractor (RAC) program. This Health Care Alert provides the most recent information from CMS regarding the start dates for automated and complex reviews, “good cause” claim reopenings, the five-level Medicare appeals process, limitations on recoupment of alleged overpayments, and charts on the RAC process and Medicare appeals process.
04/23/2009 - False Claims Act: New Rules for Pleading?
In a case that will undoubtedly be embraced by relators, the United States Court of Appeals for the Fifth Circuit recently allowed a lawsuit brought under the False Claims Act (“FCA”) to proceed even though the relator did not know certain details about the invoices he alleged were fraudulently submitted to the government. In United States ex rel. Grubbs v. Kanneganti,
the Fifth Circuit reversed a district court’s decision to dismiss an FCA claim for failure to allege fraud in sufficient detail. Although relators will argue that the decision opens the door for many more FCA lawsuits to survive early dismissal, the decision does not signal—as relators hope—that courts are abandoning heightened scrutiny.
10/08/2008 - "RACs Are On Their Way"
CMS has begun rolling out the Medicare RAC Demonstration Project on a permanent, nationwide basis. The RACs are paid solely on the amount of overpayments recovered from providers and will work cooperatively with fraud investigators and the Department of Justice. The permanent RAC program was scheduled to roll out on a national basis to the first group of states on October 1, 2008 (including Florida and Colorado), the second group of states on March 1, 2009 (including Texas and California), and the final group on August 1, 2009 (including Louisiana and New Jersey).
08/06/2008 - Whole Foods - Where Does the Federal Trade Commission Go From Here?
Whole Foods has closed its acquisition of Wild Oats, but it may not have much time to enjoy its purchase. The Federal Trade Commission had sought a preliminary injunction to block the merger to give it time to conduct a trial on the merits, but the district court denied the motion.
09/04/2007 - CMS Final Disclosure Rules on Physician Ownership & Physician Coverage of Hospital
06/25/2007 - Healthcare Legislation Update--Texas Legislature 80th Regular Session
04/27/2007 - Federal and Texas Requirements for Disclosure of Physician Ownership
01/08/2007 - Hot Topics in Health Care for Texas' 80th Legislative Session
01/05/2007 - Texas Regulatory Developments: Hospital Licensing and Pain Management Rules
12/19/2006 - 2007 Other Miscellaneous Policies Client Alert
12/01/2005 - Reminder to Update Your Policies and Procedures for 2006
10/31/2005 - Responding to Allegations of Improper Corporate Conduct
This article discusses two issues critical to any response to allegations of corporate wrongdoing: (1) structuring the internal corporate investigation in a manner that effectively responds to the allegations at issue without subjecting counsel to ethical problems that may appear along the way, and (2) dealing with the government once it launches an investigation into your corporate client, including the client’s obligation to protect relevant documents.
08/02/2005 - AmeriChoice False Claims Act Settlement and Impact on Future Medicare/Medicaid Managed Care Contract
07/07/2004 - Proposed Regulations for Ambulatory Surgical Centers Licensed by the Texas Dept. of State Health Svc