Articles and Blogs

Last week, a federal district court in Illinois entered judgment for Defendants in an FCA action against a self-proclaimed “one stop shop” health care referral management company, alleging anti-kickback and FCA violations for its arrangement with a care coordination organization for low-income seniors.[1] Originally filed in 2016, this case highlights how even an FCA... READ MORE

On July 10, 2019, the Federal Communications Commission (“FCC”) voted unanimously to move forward with its new $100 million telehealth initiative, which seeks to bring telehealth services to low-income Americans, veterans and medically underserved communities. In its Notice of Proposed Rulemaking, the FCC detailed its proposed telehealth initiative rules and anticipated program requirements. As currently... READ MORE

On July 29, 2019, the Centers for Medicare & Medicaid Services (“CMS”) released its proposed rule for Calendar Year (“CY”) 2020 Hospital Outpatient Prospective Payment System (“Proposed Rule”). Among many other changes, CMS proposed three key payment policy updates impacting hospital outpatient departments, including: (1) lowering the supervision standard for hospital outpatient therapeutic services... READ MORE

This week, CMS released the 2020 Medicare Hospital Outpatient Prospective Payment System (“OPPS”) and Ambulatory Surgical Center Payment System Proposed Rule (“Proposed Rule”). Among a host of other items, CMS announced its intent to continue paying Average Sales Price (“ASP”) minus 22.5 percent for most drugs acquired under the 340B drug discount program (“340B... READ MORE

In March of this year, a federal judge in Washington, D.C. reinstated the controversial EEO-1 Component 2 pay data reporting requirements. The current reporting deadline is September 30, 2019. The EEO-1 Pay Data Reporting Roller Coaster The EEO-1 is an annual report filed with the Equal Employment Opportunity Commission (“EEOC”) that has historically collected... READ MORE

NATIONAL Will telehealth help keep rural LTC residents healthy after discharge? Study aims to find out What Do We Know About Prices And Hospital Quality? Independent Physicians Feel The Pressure As Hospital-Owned Practices Continue To Grow Trump meets with pharma execs: 4 things to know HHS grant seeks to draw resident physicians to rural... READ MORE

Litigators and litigants should always be wary of templates, unconsidered boilerplate pleadings—and unnecessary motion practice. Last week, a federal court in Wisconsin struck boilerplate affirmative defenses that lacked “short and plain statement of the facts and…the necessary elements of the defenses.”[1] The ruling reinforced the Seventh Circuit’s standards for affirmative defenses—even though the judge... READ MORE

Senate Finance Committee Releases Drug Pricing Reform Package On July 25, the Senate Finance Committee advanced their comprehensive Medicare and Medicaid drug payment reform legislation. The bill now heads to the full Senate floor. A day earlier, Chairman Charles Grassley (R-IA) and ranking member Ron Wyden (D-OR) released the text of the chairman’s mark... READ MORE

NATIONAL More mega-mergers in Q2 drive healthcare mergers and acquisitions activity to near-historic levels Mounting battle between Amazon’s PillPack and Surescripts over access to patient data Outmigration of cardiology — Logistical challenges for ASCs + how hospitals are bracing for volume loss 2 payment models incentivizing cost-effective joint replacements Noteworthy CMS announcements, actions in... READ MORE

On July 8, 2019, the Sixth Circuit issued an employer friendly opinion strengthening the enforceability of routinely included mandatory arbitration provisions in employment contracts. In its opinion, the court rejected a former employee’s claim that “two completely different and conflicting terms” for resolution of all legal disputes rendered the mandatory arbitration clause in his... READ MORE