04/05/2012 - Appeals Court Overturns $44 Million Judgment Against Tuomey Hospital in Important Stark Law Case
The U.S. Fourth Circuit Court of Appeals has reversed a $44 million judgment against Tuomey Hospital in Sumter, South Carolina that arose from Tuomey’s employment arrangements with physicians that allegedly violated the federal Stark Law.

04/03/2012 - Fate of Health Reform is Uncertain after Supreme Court Oral Arguments
After three days of historic oral arguments before the U.S. Supreme Court, the fate of the Affordable Care Act (ACA), the momentous 2010 health reform law, is uncertain, given robust questioning of the ability of Congress to force individuals to purchase health insurance.

03/15/2012 - American Health Lawyers Association's Connections Magazine: Successor Liability in Healthcare Transactions
With the passage of the Affordable Care Act (ACA) in March 2010, Congress made the most significant change in the U.S. healthcare delivery system since the inception of the Medicare program.

02/27/2012 - Health Lawyers Weekly Guest Article: Physician Off-Label Marketing
As physician reimbursement decreases, physicians are increasingly looking to other means to replace lost income and control more of the healthcare dollar.

02/20/2012 - CMS Proposes Rules on Reporting and Returning Overpayments: Providers May Have Duty to Make Reasonable Inquiry With Deliberate Speed
The Centers for Medicare and Medicaid Services (CMS) on February 16, 2012 proposed rules implementing Section 6402(a) of the Affordable Care Act, requiring persons to report and return Medicare overpayments by the later of 60 days after an overpayment is identified or the date any corresponding cost report is due.

02/14/2012 - HIPAA Privacy and Security Audits Begin: Enforcement Measures May Follow
The Office for Civil Rights (OCR) of the U.S. Department of Health and Human Services has begun the pilot phase of HIPAA privacy and security audits of health care providers, health insurers and health care clearinghouses (“covered entities”) to assess HIPAA compliance efforts. Up to 150 covered entities will be subject to the initial audits, to be conducted by KPMG, LLP, the OCR audit contractor.

01/26/2012 - PhysBizTech Guest Article: The state Medicaid RAC audits begin...now!
Plain and simple, they are bounty hunters. They don’t hunt fugitives. They hunt for Medicaid fraud. Effective immediately, if you provide healthcare services to Medicaid patients, these bounty hunters are authorized to look for fraud in your office.

01/03/2012 - Physician Payment Sunshine Act Reports Delayed by CMS; Proposed Rule Includes Physician Owned Distributorships
The Centers for Medicare and Medicaid Services (CMS) has delayed the start date for data collection of payments made to physicians and teaching hospitals by drug and device manufacturers and group purchasing organizations (GPOs).

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.

10/31/2011 - Despite Minor Modifications in Final Rules, ACOs Still Face Large Start-Up Costs and Uncertain Savings
Under final rules issued by the Centers for Medicare and Medicaid Services (CMS), Accountable Care Organizations (ACOs) will continue to face large start-up costs and uncertain savings, despite a decreased regulatory scheme and increased financial incentives.

10/04/2011 - BNA Medical Devices Law & Industry Report Guest Article: 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 have responded to the U.S. Senate’s request for information on physician-owned distributorships (PODs).

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).

08/30/2011 - Florida Fines Medicaid HMO for Failing to Report Suspected Fraud by Providers
The Florida Agency for Health Care Administration (“AHCA”) earlier this month fined Humana $3.4 million for failing to promptly report suspected cases of Medicaid fraud and abuse by others, as required by statute and Humana’s Medicaid HMO contract. Though many states have similar laws or regulations, this appears to be the first enforcement action of its kind in the nation.

08/04/2011 - BNA Health Law Reporter Guest Article: Stringent New Health Privacy Legislation Enacted in Texas Will Present Difficult Implementation Challenges and Increased Enforcement Activity
Citing concerns that federal law does not adequately protect patient privacy, Texas recently enacted stringent new health privacy legislation that extends patient protections beyond those contained in the Health Insurance Portability and Accountability Act (HIPAA) or the Health Information Technology for Economic and Clinical Health (HITECH) Act.

07/19/2011 - Tax-Exempt Hospitals Face New Reporting Requirement of Community Health Needs Assessment
The Internal Revenue Service has proposed guidelines detailing how tax-exempt hospitals can conduct a Community Health Needs Assessment (CHNA), as required in the 2010 Patient Protection and Affordable Care Act (PPACA).

07/12/2011 - Texas Enacts New Mandates and Increased Penalties Regarding Electronic Health Records
Texas health care providers, health insurers and health clearinghouses face new mandates and increased penalties over the use of electronic health records (EHR) as a result of HB300, which was passed in the 2011 Texas legislative session and signed into law by Governor Rick Perry.

07/06/2011 - Texas Legislation Further Limits Ban on Corporate Practice of Medicine
During the 2011 legislative session that just ended, Texas Governor Rick Perry signed into law a bill that allows rural hospitals to employ physicians, known as the “corporate practice of medicine,” despite the state’s long-standing ban on such practices.

06/27/2011 - U.S. Senate Conducts Further Inquiry into Relationships Between Medical Device Manufacturers and Physicians
Earlier this week, the U.S. Senate Finance Committee requested documents and information from a medical device manufacturer related to the financial relationship between the manufacturer and physicians who conducted clinical trials of one of its devices.

06/10/2011 - Senators Criticize OIG for Lack of Guidance on Physician Joint Ventures: Request Study on Physician Owned Distributorships
A bipartisan U.S. Senate committee has asked both the Centers for Medicare & Medicaid Services (CMS) and the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services to study the proliferation of physician owned distributorships (PODs), citing a lack of regulatory guidance on how these arrangements square with existing federal law.

05/31/2011 - OCR Proposes Expansion of HIPAA and HITECH Rights: Industry to be Saddled With Large Costs; 20 Minutes to Read and Implement 24 Pages of Regulations?
The Office for Civil Rights (OCR) of the Department of Health and Human Services today proposed an expansion of the rights of individuals to obtain reports from health providers and insurers about how their protected health information (PHI) is used.

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”).

05/12/2011 - Criminal Case Against Healthcare Executive Dismissed; Government Likely to Continue Aggressive Enforcement Efforts
A former GlaxoSmithKline attorney, Lauren Stevens, was acquitted on May 10 of all criminal charges stemming from her response to an FDA investigation. The acquittal, ordered by U.S. District Judge Roger W. Titus, is a stunning defeat for the government’s anti-fraud enforcement measures.

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.

12/06/2010 - Driving Provider Integration: Implications for Hospitals and Health Systems of the Patient Protection and Affordable Care Act
On March 23, 2010, President Obama signed into law the most sweeping health care legislation since Medicare was enacted in 1965. The Patient Protection and Affordable Care Act (the “Act”) seeks to transform the American healthcare delivery system through a variety of cutting-edge initiatives and by amending a series of existing laws.