Articles and Blogs

Written by David B. Honig and Delphine P. O’Rourke Assertion of affirmative defenses creates risk for clients, attorneys and law firms.  Treating False Claims Act litigation like any other litigation will lead to the unnecessary expenditure of time and money and potentially sanctions. A recent decision out of the Southern District of Texas, United States ex rel. King v Solvay S.A.,¹ is an excellent primer... READ MORE

Hall Render is pleased to announce that shareholder William Berlin, J.D., has joined the firm’s Washington, D.C., office. Berlin’s practice consists of counseling and defending hospitals, health systems, physicians and other health care providers in federal and state antitrust enforcement agency investigations, as well as litigation, involving mergers and acquisitions, joint ventures and provider... READ MORE

Hall Render is pleased to announce associate attorney Arielle Tokorcheck, J.D., has joined the firm’s Indianapolis office. Tokorcheck practices largely within the firm’s Supply Chain Procurement, Operations & Management practice area, assisting with contracting and compliance matters affecting hospitals and health systems. She completed her undergraduate education at the University of Notre Dame in... READ MORE

CMS recently issued Advisory Opinion CMS-AO-2014-01 (“Opinion”)1 evaluating the methodology used to determine the percentage of the requesting hospital’s physician ownership as of March 23, 2010 (“Baseline Physician Ownership”).  Even though the requesting hospital executed a contribution agreement prior to March 23, 2010, CMS concluded that such action did not affect the percentage of Baseline... READ MORE

By this point, it is no secret that the federal and state antitrust enforcers are suspicious of providers’ rationales for the provider consolidation wave hitting the health care industry.  In their view, provider consolidation in highly concentrated markets leads to increased prices for hospital and physician services paid by commercial payers, which, in turn,... READ MORE

by David B. Honig and Brian C. Betner CMS Announces Further Delay of Repayment Rule To be published in the February 17, 2015 Federal Register, CMS has extended its deadline for finalizing the Affordable Care Act’s (“ACA”) 60-day payback rule. This is the rule that requires a Medicare or Medicaid provider to return an identified overpayment within... READ MORE

To be published in the February 17, 2015 Federal Register, CMS has extended its deadline for finalizing the Affordable Care Act’s (“ACA”) 60-day payback rule. This is the rule that requires a Medicare or Medicaid provider to return an identified overpayment within 60 days of its identification. On day 61, the overpayment becomes a violation of the... READ MORE

The Timeline Recently, HHS Secretary Sylvia Burwell announced an ambitious timeline for transitioning away from the fee-for-service payment system to one based on value.  Specifically, HHS’s goal is for 30% of all Medicare provider payments to be in “alternative payment models” by 2016 and for 50% of Medicare provider payments to be in alternative... READ MORE

Six- to Nine-Month SGR Patch Likely as Deadline Looms With a March 31 deadline approaching, congressional committees continue to meet and discuss how to fix the Medicare Sustainable Growth Rate (“SGR”) physician payment formula. However, health care industry lobbyists now agree that a six-to nine-month “patch” of the existing formula is more likely than lawmakers... READ MORE

On February 12, CMS hosted an Open Door Forum on the upcoming changes to the Nursing Home Compare Five-Star rating system.  These changes will be effective on February 20th.  Nursing facilities will be able to privately view their revised ratings by mid-morning on Friday, February 13, via their MDS portal login. The updated scoring system may... READ MORE