The Office of Inspector General of the U.S. Department of Health and Human Services (the OIG) recently released an updated General Compliance Program Guidance document (GCPG). The GCPG has been anticipated since the OIG announced on April 25, 2023, that it planned to modernize the accessibility and usability of its publicly available resources, including the OIG’s Compliance Program Guidance (CPG) documents. We recommend that the healthcare compliance community and other healthcare stakeholders review the GCPG carefully, and, in particular, that all healthcare compliance officers ensure they use the GCPG as a guidebook going forward.
ACTION REQUIRED TO AVOID FINES! DEADLINE APPROACHING: Florida Pharmacy Benefit Managers Must Be Licensed as a Third-Party Administrator by January 1, 2024
Posted in Government Affairs, Licensure & Regulatory, Healthcare Law, Pharmacy, Drugs, Medical Devices & EquipmentPharmacy Benefit Managers (PBMs) take note! Under Florida’s new Prescription Drug Reform Act, PBMs must be licensed as an insurance administrator (also known as a third-party administrator, or TPA). Under this new law, any entity that wishes to provide PBM services after January 1, 2024, must be licensed as a TPA.
THE NO SURPRISES ACT: Hoping for an End to the Surprises
Posted in Health Insurers & Managed Care Organizations, Healthcare Law, Healthcare Litigation, Hospitals & Health Systems, PhysiciansBy looking at the events that have transpired since the Consolidated Appropriations Act, 2021, which includes the No Surprises Act (the Act), was signed into law, it is clear that the Departments of Health and Human Services, Labor, and Treasury (collectively, the Departments) have lost their way. The United States District Court for the Eastern District of Texas (the Texas court) has consistently agreed with providers and ruled against the Departments because they have repeatedly violated the Administrative Procedure Act (APA) and disregarded the original intent of the Act: to protect consumers from surprise medical bills and to streamline disputes between payors and providers through an independent dispute resolution process (IDR).
Surprise… No Surprises Act Arbitration Is Too Expensive
Posted in Health Insurers & Managed Care Organizations, Healthcare Law, Healthcare Litigation, Hospitals & Health Systems, PhysiciansProviders finally obtained court ordered relief to the $350 administrative fee each party was required to pay as part of the Federal Independent Dispute Resolution (IDR) Process under the No Surprises Act. Until the Departments of Health and Human Services, Labor, and the Treasury (collectively, the Departments) set a new administrative fee amount, the administrative fee for disputes initiated on or after August 3, 2023, will be $50 per party per dispute.
Teva FCA Decision Sheds Light on Varying Interpretations of the Elements of an FCA Claim
Posted in Fraud & Abuse & False Claims Act, Healthcare LitigationHow could alleged kickbacks threaten to render insolvent a publicly traded company with assets (taken from its latest SEC filing) in excess of $43 billion? The answer stems from a recent decision by the United States District Court for the District of Massachusetts. In its ruling denying the motion for summary judgment filed by defendants Teva Pharmaceuticals USA, Inc. and Teva Neuroscience, Inc. (collectively Teva) and granting the government’s partial summary judgment motion, the court ruled that
OCR and FTC Issue Warning to Hospital Systems and Telehealth Providers about Tracking Technologies
Posted in Health Care Providers, HIPAA, Privacy, and Data Security, TechnologyOn July 20, 2023, the U.S. Department of Health and Human Services Office for Civil Rights (OCR) and the Federal Trade Commission (FTC) announced they were sending a joint letter to approximately 130 unidentified hospital systems and telehealth providers highlighting the agencies’ concerns about the use of tracking technologies on websites and mobile apps in violation of HIPAA. While the joint letter was directed to a small number of recipients, in the announcement OCR and the FTC encouraged all companies they regulate to review their data-tracking practices and ensure that their tracking technologies are not impermissibly disclosing consumers’ sensitive personal health data to third parties. The letter — and the decision to publicly announce its existence — suggests that OCR and the FTC are likely to prioritize the enforcement of HIPAA and other laws against those entities that the agencies believe are impermissibly using tracking technologies.
OIG Issues Information Blocking Penalties Final Rule: Health IT Developers and Health Information Exchanges/Networks Have a Million Reasons to Care
Posted in Electronic Health Records & Medical Records, Fraud & Abuse & False Claims Act, TechnologyOn June 27, 2023, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) issued its long-anticipated final rule amending the OIG’s civil monetary penalty (CMP) regulations as they relate to information blocking (CMP Final Rule or Rule). The CMP Final Rule was published in the Federal Register on July 3, 2023. The Rule applies to entities that develop or offer certified health IT (collectively, Developers) and health information networks and health information exchanges (collectively, HIN/HIEs). Those subject to the CMP Final Rule should consider prioritizing their compliance efforts because the OIG will begin enforcing the Rule on September 1, 2023. Below we discuss the applicability of the CMP Final Rule, the assessment of penalties under the Rule, and the OIG’s enforcement priorities moving forward.
The Supreme Court Clarifies the Government’s FCA Dismissal Power and Invites Constitutional Challenge to the FCA’s Qui Tam Provision
Posted in Fraud & Abuse & False Claims ActFor the second time this month, the United States Supreme Court addressed a circuit split involving the False Claims Act (FCA, 31 U.S.C. §§ 3729 – 3733). Earlier, in the SuperValu decision (discussed in a recent Health Law Rx Blog), the Court clarified that subjective intent is relevant in determining whether an objectively reasonable (but incorrect) interpretation of a rule or regulation could negate the FCA’s scienter element (U.S. ex rel. Schutte v. SuperValu Inc., 143 S.Ct. 1391, 1401 (U.S. 2023)). Last week, in U.S. ex rel. Polansky v. Executive Health Resources, Inc., the Court held that, despite declining to intervene at the outset of a case, the Government retains the authority to intervene later, including for the purposes of seeking dismissal pursuant to and consistent with Federal Rule 41(a) (U.S. ex rel. Polansky v. Exec. Health Res., Inc., No. 21-1052, 2023 WL 4034314, at *2 (U.S. June 16, 2023)).
Health Apps Beware: FTC Clarifies Health Breach Notification Rule with Significant Proposed Changes
Posted in Health Care Providers, HIPAA, Privacy, and Data Security, Pharmacy, Drugs, Medical Devices & Equipment, TechnologyDirect-to-consumer health and wellness applications are forewarned: the Federal Trade Commission (FTC) is proposing changes to the Health Breach Notification Rule (HBNR), 16 C.F.R. part 318, that, if finalized, would cement the HBNR’s applicability to a broad swath of direct-to-consumer health and wellness applications (apps) and confirm that a breach of security includes not only data security incidents, but also unauthorized disclosures of personal health information. The FTC issued the Notice of Proposed Rulemaking on May 18, 2023, and comments are due 60 days after publication in the Federal Register. We have prepared a comparison document illustrating the proposed changes, which can be found here.
SafeCo No More: The Changing Landscape of Scienter under the False Claims Act
Posted in Fraud & Abuse & False Claims Act, Healthcare LitigationYesterday, the United States Supreme Court held that a False Claims Act (FCA) defendant cannot rely on an objectively reasonable interpretation of a law, regulation, or rule to negate the scienter element of the FCA. In United States ex rel. Schutte v. SuperValu Inc., the Court emphasized the importance of a defendant’s subjective belief in resolving the scienter element. [1] In so doing, the Court has removed a valuable argument from the FCA defense toolkit.
