Articles and Blogs

Recently, a Pennsylvania-based physician group practice successfully defended an employment discrimination suit, thanks in part to its robust coding review process and auditing of its physicians’ prescribing habits. The physician plaintiff filed a discrimination suit under the Americans with Disabilities Act (“ADA”), the Age Discrimination in Employment Act and the Pennsylvania Human Relations Act. ... READ MORE

The U.S. Supreme Court handed down its opinion yesterday in the case of Mayo Collaborative Servs., dba Mayo Med. Labs., et al. v. Prometheus Labs., Inc. (No. 10-1150) (March 20, 2012) (see PDF here).  The Court reversed the U.S. Court of Appeals for the Federal Circuit and held that the patent claims at issue... READ MORE

As a means of improving care to residents residing in Medicare/Medicaid nursing facilities, CMS announced on March 15, 2012 an initiative to help reduce avoidable hospitalizations.  Organizations interested in participating in this initiative must submit an application to CMS by June 14, 2012. The goal of the initiative is to improve care for residents... READ MORE

Three and a half months ago, Congress included language in the National Defense Authorization Act (“NDAA”) declaring that TRICARE network providers will not be subject to OFCCP’s jurisdiction solely on the basis of their TRICARE network agreements.  The NDAA did not, however, address OFCCP coverage over health care providers in any other context, nor... READ MORE

Three and a half months ago, Congress included language in the National Defense Authorization Act (“NDAA”) declaring that TRICARE network providers will not be subject to OFCCP’s jurisdiction solely on the basis of their TRICARE network agreements.  The NDAA did not, however, address OFCCP coverage over health care providers in any other context, nor... READ MORE

The Office of Inspector General (“OIG”) issued its first opinion of 2012 on March 8th and posted it on its website yesterday.  In Advisory Opinion #12-01, the OIG issued a favorable opinion regarding a health system’s (“Health System”) proposal to form a wholly-owned group purchasing organization (“GPO”) to be the primary GPO for the... READ MORE

Last month the Centers for Medicare & Medicaid Services (CMS) published proposed rules for reporting of overpayments. These proposed rules, if adopted and strictly interpreted, could effectively create a twenty-year statute of limitations under the False Claims Act. READ MORE

As expected earlier this month, the Centers for Medicare & Medicaid Services (CMS) have just released guidance for health facilities wishing to utilize specific features now available in the 2012 Life Safety Code (LSC).  As previously discussed, the updated LSC provides new ways for nursing facilities to adopt a more home-like setting.  The recent... READ MORE

The U.S. Department of Health and Human Services (“HHS”) Office for Civil Rights (“OCR”) announced on Tuesday, March 13, 2012, that Blue Cross Blue Shield of Tennessee (“BCBST”) will pay $1,500,000 to settle potential violations of the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”).  BCBST had previously notified HHS that 57 unencrypted hard drives containing protected health information, social... READ MORE

February was an interesting month, with one case showing how OIG advisory opinions can be taken too far, another considering fraud under a corporate integrity agreement, and a court applying burden-shifting for the first time at the appellate level in FCA retaliation cases. Cases reviewed from February are: US ex rel. Boggs v. Bright Smile... READ MORE