Category Archives: Healthcare Law

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Florida Supreme Court: Referral Sources Can Be Protected By A Non-Compete

Big news for home health agencies and others whose business comes from referral sources: the Florida Supreme Court just held that referral sources are the kind of protectable business interest that will support a non-compete agreement. Home health agencies, like other health care businesses, routinely use non-compete agreements to prevent marketing employees from leaving and going to work for direct … Continue Reading

Medicare Fraud Strike Force Strikes Again – in a Big Way

The Medicare Fraud Strike Force initiated its largest ever healthcare enforcement action, charging 412 defendants in July 2017 with approximately $1.3 billion in fraudulent claims. The Strike Force consists of teams that include the Office of Inspector General, the Department of Justice, Offices of the United States Attorneys, the Federal Bureau of Investigation, and local law enforcement, with efforts concentrated … Continue Reading

New York State Enforces Data Breach Notification Law

Earlier this month, New York Attorney General Eric Schneiderman announced his state had entered into a settlement with CoPilot Provider Support Services, Inc. (CoPilot)—a settlement resulting from CoPilot’s violation of the data breach notification requirements of the New York General Business Law (GBL) that requires companies, among other things, to provide notice of a breach as soon as possible. Under … Continue Reading

Senate Healthcare Bill Released for Public Review

Just over four weeks after the Congressional Budget Office (CBO) released its score of the American Healthcare Act (AHCA), the bill passed by a narrow margin in the U.S. House of Representatives, the U.S. Senate released ‘The Better Care Reconciliation Act of 2017’. Upon initial review, we are providing a quick overview of this proposed legislation. … Continue Reading

Repeal of the Affordable Care Act Will Not Include Changes to Tax Exempt Hospitals’ 501(r) Charitable Care Obligations

While the Senate Budget Committee works to draft legislation to reconcile the American Health Care Act, the repeal and replace bill passed by the House, there is no expectation of a repeal of the charitable care obligations imposed on tax exempt hospitals under Section 501(r) of the Internal Revenue Code as part of the Affordable Care Act.… Continue Reading

ERISA Exemption Upheld for Religious-Affiliated Hospitals

Hospitals that are “church-affiliated” may be breathing easier this week, following the U.S. Supreme Court’s decision on Monday that defined benefit qualified retirement plans (a/k/a pension plans) are not subject to the Employee Retirement Income Security Act (ERISA). The Supreme Court confirmed that ERISA does not require an exempt “church plan” to have actually been established by the church itself.  … Continue Reading

“Sometimes Wrong, Never in Doubt” – A New Perspective?

Two recent studies of medical malpractice claims highlight how patient complaints may identify those surgeons at greater risk for complications, a significant decrease in paid medical malpractice claims since 1992, and the need for greater understanding of the causes of differences in claims experience across medical specialties.… Continue Reading

The American Health Care Act, the Sequel Receives Its CBO Grade

Perhaps the high fives in the Rose Garden of the White House a few weeks ago may have been a bit premature. On Wednesday, May 24, 2017, the non-partisan Congressional Budget Office (CBO) released its analysis of the revised American Health Care Act (AHCA), and the review contained positive budgetary news, but the overall impact of the bill on health … Continue Reading

The American Health Care Act: Now What Happens?

To great fanfare by both the leadership of the Republican caucus in the House of Representatives (the House) and President Trump, on May 4, 2017, the American Health Care Act (AHCA), the proposed successor/replacement to the Affordable Care Act (ACA), passed the House by a narrow vote of 217-213. Unsurprisingly, no member of the Democratic Party in the House voted … Continue Reading

April Showers Bring More HIPAA Settlements

April proved to be a busy month for the U.S. Department of Health and Human Services Office for Civil Rights (OCR) under its newly appointed director, Roger Severino. OCR announced three settlements of potential HIPAA violations totaling nearly $3,000,000.00 in fines. The settling parties include a wireless health services provider, a federally-qualified health center (FQHC), and a pediatric specialty provider. … Continue Reading

Lack of Timely Action and Knowledge of Risk Results in $3.2 Million Civil Monetary Penalty for HIPAA Violations

Children’s Medical Center of Dallas (Children’s) was hit with a $3.2 million civil penalty from the U.S. Department of Health and Human Services, Office for Civil Rights (OCR) for failing to take steps to properly protect patient medical information. The civil penalty is the result of two data breaches caused by a lack of encryption and what was described as … Continue Reading

Potential Implications to the ACA Under the Incoming Republican Administration – Part IV: Pharmacies

The Affordable Care Act (ACA), as a whole, did not have a significant impact on pharmacy services per se. However, a complete repeal would likely impact certain areas of pharmacy services including the drug benefit for the exchange plans, the donut hole for Medicare Part D, states’ necessary Medicaid rebates, and certain recipients of 340B drugs.… Continue Reading

Potential Implications to the ACA Under the Incoming Republican Administration – Part III: Hospitals

President Trump has been clear in his intention to repeal the ACA. In fact, among President Trump’s first executive orders was one seeking to “minimize the economic burden” associated with the Patient Protection and Affordable Care Act (ACA). In addition to calling for its prompt repeal, he calls upon the executive branch to minimize the regulatory burdens of the ACA … Continue Reading

Potential Implications to the ACA Under the Incoming Republican Administration – Part II: Physicians

In contemplating the ways in which physicians may be affected by the possible repeal of the Affordable Care Act (ACA)—and certain features of any legislation that may replace it—a good place to start is with the person selected by President Trump to be the Secretary of the Department of Health and Human Services (HHS) – Representative Tom Price of Georgia, … Continue Reading

The AHA’s Letter to Santa Claus

The American Hospital Association, after having been “nice” all year, penned its letter to Santa Claus with its wish list for Christmas. Its four page letter (actually addressed to President-Elect Donald Trump at 1717 Pennsylvania Avenue, not Santa at the North Pole) advised the incoming President of its own public policy priorities and their vision for healthcare reform. Some of … Continue Reading

Are Recommendations of the White House Task Force on Behavioral Health Parity Trumped by the Election?

Recently the White House Behavioral Health Parity Task Force issued guidance on the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (Parity Law). The Task Force could not have known, though, that on November 8th, the election may have changed the direction of the Task Force report and subsequent implementation. … Continue Reading

HHS Publishes a New Rule to Protect Dialysis Patients From Being “Steered” into Private Coverage for the Benefit of Dialysis Centers

On implementing significant, new requirements for Medicare-certified dialysis facilities that make payment of premiums for individual health coverage, on December 14, 2016, the Department of Health and Human Services (HHS) published an Interim final rule with comment period. The regulations become effective 30 days after the date of publication – January 13, 2017, and comments regarding the interim must be … Continue Reading

Recent CyberSecurity Incidents Emphasize Importance of Cyberinsurance

As the threat of cyberattacks continues to pose daily threats to businesses large and small, more companies have turned to cyber insurance products to shore up protection against these disruptive threats. A spate of recent incidents has highlighted the importance of taking steps to prepare for and mitigate possible damages. As such, healthcare entities have begun exploring Cyberinsurance as a … Continue Reading

The Florida Agency for Health Care Administration Releases an Invitation to Negotiate for a Vendor to Provide an All Payor Claims Database to Florida Consumers

The Florida Agency for Health Care Administration (AHCA) released ITN 003-16/17 (the “ITN”) to select a vendor to provide All Payer Claims Database (APCD) services pursuant to section 408.05(3)(c), Florida Statutes. The ITN, published on September 26, 2016, contains a tight time-frame for the submission and evaluation of responses to it. While written inquiries regarding the ITN must be … Continue Reading

The Changing Meaning of Healthy: FDA Seeks Public Input About Healthy Foods

In the 1990s, food had to be low in fat in order to be considered healthy. Those were the days of Snack-Wells cookies and fat-free salad dressings. How times have changed. Now health professionals consider many higher-fat foods such as almonds, avocado, eggs, and salmon to be healthy. Conversely, some low-fat but artificial, processed foods are no longer deemed healthy.… Continue Reading

CMS Postpones Pre-Claim Review Demonstration for Home Health Services

The Centers for Medicare & Medicaid Services (CMS) announced that it would postpone the initiation of the CMS Pre-Claim Review Demonstration for Home Health Services (the “Demonstration”) in Florida, which was scheduled to begin in October 2016. The start dates for Texas, Michigan and Massachusetts, which are also part of the Demonstration, have not yet been announced, but were originally … Continue Reading

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