Written by Kimberly Gold Most state and federal health care investigations are prompted by audits or claims brought by whistleblowers. But a recent newspaper article about a debt collection company’s tactics has prompted Congressional ire and potentially a federal investigation. On April 24th, a New York Times article highlighted Accretive Health’s alleged debt collection practices after… Continue Reading
Category Archives: Hospitals & Health Systems
Subscribe to Hospitals & Health Systems RSS FeedAnalysis of Health Insurer-Hospital Vertical Merger Submitted to ABA/AHLA Antitrust in Healthcare Conference
Posted in Antitrust, Hospitals & Health Systems, Mergers, Acquisitions & Other Transactions, Payors & PBMsChristi Braun and Farrah Short have submitted a paper for the 2012 ABA/AHLA Antitrust in Healthcare Conference in which they discuss the proper role of antitrust enforcement in achieving today’s health care reform goals in the context of hospital-health insurer vertical mergers. The paper focuses on the recent acquisition of the West Penn Allegheny Health System,… Continue Reading
CMS To Pay Hospitals Over $3 Billion for CMS’ Miscalculation
Posted in Hospitals & Health Systems, Reimbursement, State & Federal Audits, Investigations & Litigation, UncategorizedHospital chains Hospital Corporation of America (HCA) and Tenet Healthcare Corporation (Tenet) announced on April 12th that the Centers for Medicare & Medicaid Services (CMS) has admitted that it erroneously calculated the rural floor provision established by the Balanced Budget Act of 1997. According to the HCA press release: [T]he rural floor provision establishes that a]… Continue Reading
HHS Issues Report to Congress on the Self-Referral Disclosure Protocol
Posted in Clinical Laboratories, Fraud & Abuse, Health Care Reform, Hospitals & Health Systems, Physicians, State & Federal Audits, Investigations & LitigationWritten by Tom Crane and Brian Dunphy On March 23, 2012, the Department of Health and Human Services (HHS) issued its statutorily required report to Congress (Report) describing the implementation of the Medicare Physician Self-Referral Disclosure Protocol (SRDP) and the status of disclosures under the SRDP to date. The SRDP was authorized by the Affordable Care… Continue Reading
FTC Petitions for Rare Supreme Court Review of Hospital Acquisition
Posted in Antitrust, Hospitals & Health Systems, Mergers, Acquisitions & Other Transactions, State & Federal Audits, Investigations & LitigationWritten by Christi Braun, Matthew Cohen, and Bruce Sokler Last week, the Solicitor General, at the request of the Federal Trade Commission (FTC), petitioned the U.S. Supreme Court to review a ruling of the Eleventh Circuit regarding the acquisition of Palmyra Park Hospital (Palmyra) in Albany, Georgia by Phoebe Putney Health System (PPHS). In December 2010,… Continue Reading
OIG Approves Wholly Owned Subsidiary GPO Arrangement
Posted in Fraud & Abuse, Hospitals & Health SystemsWritten by Theresa Carnegie and Nili Yolin In Advisory Opinion 12-01, the Office of Inspector General for the Department of Health and Human Services (OIG) analyzed a proposal from a nonprofit health system (the “System”) to form a group purchasing organization (the “Proposed GPO”) for the benefit of the System’s affiliates and subsidiaries. … Continue Reading
New York Court Finds Private Right of Action Under State’s Prompt Pay Law
Posted in Hospitals & Health Systems, Long-term Care/Skilled Nursing Facilities, Payors & PBMs, ReimbursementWritten by Nili S. Yolin On February 22, 2012, a New York State Court held for the first time that a provider may bring a claim against a health insurer under the State’s prompt pay law (PPL). New York’s PPL states that where there is an undisputed obligation to pay a claim, the insurer must… Continue Reading
ACGME Announces its Next Accreditation System
Posted in Accreditation Council for Graduate Medical Education, Accreditation, Licensing & Certification, ACGME, Hospitals & Health Systems, UncategorizedWritten by Andrew B. Roth and Nili S. Yolin On February 22, 2012, the Accreditation Council for Graduate Medical Education (ACGME) announced the roll-out of its “Next Accreditation System” (NAS) for all graduate medical education (residency and fellowship) programs that hold ACGME accreditation. The ACGME, the accrediting agency for approximately 9,000 residency programs in 133 specialties… Continue Reading
Massachusetts Corporate Practice of Medicine Regulations Finalized
Posted in Clinical Laboratories, Home Health & Hospice, Hospitals & Health Systems, Long-term Care/Skilled Nursing Facilities, PhysiciansWritten by Rachel Irving and Ellen Janos The Massachusetts Board of Registration in Medicine recently released final revised physician licensing and discipline regulations, effective February 1, 2012. The final regulations mark the end of a six-year process to overhaul these regulations. Although the disciplinary regulations generated a great deal of controversy within the physician and hospital community,… Continue Reading
Case Study: Messner v. Northshore University HealthSystem
Posted in Antitrust, Hospitals & Health Systems, State & Federal Audits, Investigations & LitigationLaw360 recently published an interesting article examining the Seventh Circuit’s recent opinion in Messner v. Northshore University HealthSystem. Written by my colleagues Christi Braun, Rob Kidwell, Kevin McGinty, and Bruce Sokler, the article provides an in-depth analsyis of the Messner decision, which involves significant class certification issues as well as an important analysis of antitrust harm in the… Continue Reading
Cuomo Issues Executive Order Regarding Limits on Executive Compensation
Posted in Hospitals & Health Systems, Payors & PBMs, UncategorizedWritten by Brian Platton After withdrawing nearly identical proposed legislation one day earlier, on January 18, 2012, New York Governor Andrew Cuomo issued an Executive Order directing certain New York State agencies, including the Department of Health, to promulgate regulations that limit the compensation of executives of entities that receive state funding or payments from… Continue Reading
D.C. Circuit Finds Physicians Can Pursue Challenge to Stark Law Regulation
Posted in Fraud & Abuse, Hospitals & Health Systems, Physicians, State & Federal Audits, Investigations & LitigationWritten by Tom Crane The D.C. Court of Appeals gave Medicare providers and suppliers a holiday gift last week with the issuance of a rare jurisdictional ruling involving a challenge to the Stark Law regulations. For years, CMS had interpreted the Stark Law as permitting physicians to act as service providers to hospitals furnishing an… Continue Reading
Rockford Rerun: FTC Sues to Stop Hospital Merger
Posted in Antitrust, Hospitals & Health Systems, Mergers, Acquisitions & Other Transactions, State & Federal Audits, Investigations & LitigationMy colleagues Christi Braun, Rob Kidwell, and Bruce Sokler have authored a health care antitrust advisory detailing an administrative complaint and a district court complaint recently filed by the FTC to block OSF Healthcare System’s proposed acquisition of Rockford Health System. The FTC sees the merger as a rerun of the government’s successful challenge of a similar hospital merger in Rockford in… Continue Reading
Spending to Save: Innovation Challenge Grants Seek Better Outcomes at a Lower Cost
Posted in Accountable Care Organizations, Health Care Reform, Home Health & Hospice, Hospitals & Health Systems, Long-term Care/Skilled Nursing Facilities, UncategorizedWritten by Jared Alves and Kevin Kappel Stakeholders across the health care spectrum will soon compete for $1 billion in grants offered by the Health Care Innovation Challenge. The initiative, funded as part of the Patient Protection and Affordable Care Act, was announced by the Centers for Medicare and Medicaid Services (CMS) on November 14th… Continue Reading
OIG Approves Arrangement Based on New Exception to Beneficiary Inducement Prohibition
Posted in Fraud & Abuse, Hospitals & Health SystemsWritten by Karen Lovitch and Stephanie Willis In OIG Advisory Opinion 11-16, the OIG found that a Domiciliary Services Program (the “Program”) offered by a non-profit research hospital (the “Requestor”) is protected from enforcement under the Anti-Kickback Statute and the prohibition on beneficiary inducement found in the civil monetary penalties law (the “CMP law”). Through the Program, the Requestor (described… Continue Reading
New Coalition Formed to Tackle Care for Advanced Illness
Posted in Health Care Reform, Home Health & Hospice, Hospitals & Health Systems, Long-term Care/Skilled Nursing Facilities, Payors & PBMs, PhysiciansWritten by Kevin Kappel Last week a recently formed group called the Coalition to Transform Advanced Care (C-TAC) announced its action plan to improve health care delivery for the sickest and most vulnerable Americans – those with advanced illness. According to C-TAC, advanced illness “occurs when one or more conditions become serious enough that general… Continue Reading
CMS, OIG, DOJ, FTC Release New Interim and Final Rules on ACOs
Posted in Accountable Care Organizations, Fraud & Abuse, Hospitals & Health Systems, Reimbursement, UncategorizedWritten by Stephanie D. Willis Today, CMS released the final rule that will implement the Medicare Shared Savings Program (MSSP) mandated by section 3022 of the Affordable Care Act. Simultaneously, the Department of Justice’s Antitrust Division and the Federal Trade Commission released their joint “Statement of Antitrust Enforcement Regarding Accountable Care Organizations Participating in the… Continue Reading
Innovation Center Extends Bundled Payments Initiative Application Deadlines
Posted in Accountable Care Organizations, Health Care Reform, Hospitals & Health Systems, Payors & PBMs, Reimbursement, UncategorizedWritten by Stephanie Willis The Center for Medicare and Medicaid Innovation has extended the deadlines for submitting letters of intent and final applications for participation in the Bundled Payments for Care Improvement Initiative. On August 23rd, Innovation Center Director Dr. Rick Gilfillan, together with Valinda Rutledge, Director of the Patient Care Models Group, and Senior… Continue Reading
OIG Advisory Opinion Permits Donation of Telemedicine Items and Services
Posted in Fraud & Abuse, Hospitals & Health SystemsWritten by Brian Dunphy, Karen Lovitch, and Stephanie Willis In a recent advisory opinion, the OIG allowed a hospital to share telemedicine resources with another hospital, in the interest of promoting new models of consultation and improving patient care by reducing unnecessary patient transfers. In the opinion, the OIG gave the green light to a proposed arrangement… Continue Reading
State of New York Forms Task Force Targeting Excessive Compensation at Nonprofits
Posted in Hospitals & Health Systems, Long-term Care/Skilled Nursing Facilities, Payors & PBMsWritten by Nili Yolin New York not-for-profit organizations, including hospitals, nursing homes, and managed care organizations, may need to look beyond the IRS “intermediate sanctions” regulations when setting their executives’ compensation now that Governor Andrew Cuomo’s newly formed Task Force on Not-For-Profit Entities will be reviewing these compensation levels. The Task Force has already begun… Continue Reading
