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Mark H. Gallant

Co-Chair, Health Law

: Philadelphia
One Liberty Place
1650 Market Street
Suite 2800
Philadelphia, PA 19103
P: (215) 665-4136
TF: (800) 523-2900
F: (215) 701-2436

Mark H. Gallant

Mark is co-chair of the firm's Health Care Practice Group concentrating his practice in client counseling and litigation involving federal and state regulation of health care providers and third-party payers. Prior to entering private practice in Philadelphia in 1988, Mark served as the deputy chief counsel to the Centers for Medicare & Medicaid Services in Washington, D.C., where he managed all litigation under the Medicare and Medicaid programs for the federal government nationally. Prior to that, Mark served for more than 10 years with the Civil Division of the U.S. Justice Department and U.S. Attorney's Office in D.C.

Perennially listed in The Best Lawyers in America and selected as a Pennsylvania “Super Lawyer" by his peers, Mark is a recipient of Martindale-Hubbell’s highest rating. He has written and lectured widely for the American Health Lawyers Association, Pennsylvania Bar Association, and other organizations on Medicare and Medicaid reimbursement, state/federal regulations under the Medicaid program, Medicaid managed care and compliance with health care fraud and abuse laws, and serves as a co-chair of AHLA’s annual Medicare and Medicaid Reimbursement Institute. He also is the author of the Medicaid Reimbursement section of the American Health Lawyers Association (Clark, Boardman, Callaghan) Health Law Practice Guide and speaks regularly at AHLA and Pennsylvania Bar Institute programs on governmental and third-party payer health care reimbursement and fraud issues. He also serves as a planning committee member and co-chair for AHLA’s Annual Medicare and Medicaid Reimbursement Institute in Baltimore.

Mark has served as counsel of record in litigation and other matters for health care systems, hospitals, pharmacy chains, durable medical equipment manufacturers and suppliers, long-term care providers, and for national and state trade associations. Mark’s representative matters for health care industry clients have included:

• Litigation resulting in the invalidation of CMS reaudit rule that prevented teaching hospitals from adding misclassified teaching costs to their base-year Average Per Resident Amounts.

• Defense of False Claim Act investigations and qui tam suits, including settlement of a Medicare “outlier” fraud case with no corporate integrity agreement.

• Rulemaking comments on behalf of national trade association contesting CMS’ proposal to eliminate Medicaid funding for graduate medical education costs.

• Formulation and legal audits of provider taxes and intergovernmental transfers (IGTs) on behalf of hospital, trade association, and governmental clients.

• Suits and high stakes arbitrations against private third-party payers and Medicaid managed care plans (involving down-codes, disallowances, breach of contract claims, and out-of-network reimbursements).

• Negotiations and restructuring of third-party payer contracts.

• Successful suits against various states challenging reductions to Medicaid reimbursement, including budget-driven Medicaid cuts and rate discrimination against out-of-state providers.

• Litigation resulting in the Third Circuit University Medical Center rule (prohibiting Medicare recoupments against health care providers operating in bankruptcy reorganization).

• Part A reimbursement hearings before the Provider Reimbursement Review Board, including a PRRB decision striking CMS’ requirement for filing duplicate claims forms with Part A intermediaries as a condition of receiving medical education supplements for Medicare managed care enrollees.

Mark earned his undergraduate degree from Rutgers University-New Brunswick in 1972 and his law degree from Georgetown University Law Center in 1975.

Experience

Represented New Jersey Hospital Association in New Jersey Hospital Ass'n v. Waldman, 73 F.3d 509 (3d Cir. 1995). Challenge by New Jersey hospitals to reduction of DRG rates and adequacy of disproportionate share payments.

Represented Children's Seashore House in Children's Seashore House v. Waldman, 197 F. 654 (3d Cir. 1999), affirming constitutional claim to require state to pay Medicaid disproportionate share adjustments to out-of-state providers.

Provided guidance to hospital client regarding inter-relationship of state and federal patient safety laws.

Assisted a local hospital obtain training reimbursement rates from Medicare after an eight year fight from the initial administrative appeal challenging the government's interpretation of its re-audit rules to a federal case in the Third Circuit. The court ordered the government to recalculate its reimbursements without reliance on its discriminatory re-audit rule.

Prohibited Medicare program from recouping pre-petition overpayments from hospitals that have filed for bankruptcy in In re: Universal Medical Center, 973 F.2d 1065 (3d Cir. 1992).

Defended a multi-state provider of behavioral health services against a False Claims Act suit brought by the federal and state governments, and advised the client with respect to its obligations under a resulting Corporate Integrity Agreement.

Represented the American Hospital Association and Association of American Medical Colleges as friends of the court in In re: Cardiac Device Litigation (Second Circuit U.S. Court of Appeal) involving Medicare billings for services including investigational devices.

Represented physician group practices before the New Jersey Board of Medical Examiners in connection with compliance with the New Jersey anti-referral law, commonly referred to as the "Codey Law."

Represented a national pharmacy chain in various regulatory counseling on manufacturer rebate programs, patient refill compliance programs, federal fraud and abuse compliance, and issues related to an affiliated PBM.

Represented a national pharmacy chain in regulatory advice and defense of claims by state PACE programs involving application of mandatory discounts.

Represented the National Association of Chain Drug Stores on numerous projects, including a comprehensive analysis of the statutes, regulations, and case law governing reimbursement requirements and rate reductions by State Medicaid programs and in the Massachusetts District Court AWP rebate and pricing litigation.

Served as counsel to a national long term care pharmacy specialty provider in connection with Pennsylvania Medicaid rate setting and compliance issues.

Represented national nursing home chain in Medicare Part A appeals involving "related party" (institutional pharmacy) reimbursements.

Served as compliance counsel for several long term care organizations.

Represented a major hospital center in an arbitrated dispute with a Medicaid Managed Care Organization (MCO). Over the hospital’s objection, the MCO sought to justify failures to pay for hospital services on medical necessity grounds, even though the MCO had denied the relevant claims solely for lack of authorization. After the arbitrator ruled in the hospital’s favor on this issue and a variety of others, the matter settled on favorable terms for our client.

Represented an air ambulance company in a dispute with a Medicaid managed care organization (MCO) that refused to pay more for out-of-network transportation services than the federal default rate applicable to emergency hospital services. We brought suit alleging that the default rate did not apply, that the MCO had breached an implied-in-fact contract with the company and the terms under which it participated as a Medicaid plan, and that the MCO had been unjustly enriched. After the court denied most of a motion to dismiss by defendant, the matter settled on favorable terms for our client.

Won summary judgment, which was affirmed by the U.S. Court of Appeals for the Third Circuit, on behalf of an employee health plan operated by a health system in an ERISA case involving the recovery of a substantial overpayment to an out of network health care provider by the plan on behalf of a plan beneficiary. The court's opinion clarifies ambiguities in recent Supreme Court cases governing recoveries by ERISA plans based on equitable liens by agreement. The court found that our client’s claims were equitable rather than legal and thus permitted by ERISA, and awarded the plan an equitable lien by agreement based on a provision of the Plan requiring the return of overpayments made in error. The plaintiff was ordered to repay our client the substantial overpayments. Additionally, we won summary judgment on the provider's ERISA claims against our client, through which the provider sought $1.2 million in reimbursement based on its full billed charges.

News

Seven Cozen O’Connor Lawyers Named 2019 “Lawyers of the Year” by Best Lawyers in America

August 31, 2018

Cozen O’Connor is proud to announce that seven of the firm’s lawyers have been recognized as “Lawyers of the Year” in their respective practices by Best Lawyers in America, one of the oldest and most highly regarded peer review publications in the legal profession.

126 Cozen O’Connor Attorneys Named to the Best Lawyers in America

August 22, 2018

One hundred twenty-six Cozen O’Connor lawyers from 20 of the firm’s national offices have been selected for inclusion in the 2018 edition of The Best Lawyers in America.

Medicaid Work Rules Lawsuit Could Have Far-Reaching Impact

June 13, 2018

Mark Gallant, co-chair of Cozen O'Connor's Health Care practice group, spoke with CQ Roll Call about a recent Medicaid lawsuit in Kentucky.

100 Cozen O’Connor Lawyers Named to the Best Lawyers in America

August 23, 2017

Lawyers were selected for inclusion in the 2018 edition based on a rigorous peer-review that has been developed and defined for more than 30 years.

Cozen O’Connor Earns Client Recognition in 2017 Chambers USA Rankings

May 26, 2017

Chambers USA recognized 47 Cozen O’Connor lawyers as leaders in their respective fields; 14 attorneys were recognized nationally and 11 were ranked in the top band.

Wills Eye Takes Medicare Fight to Federal Court

December 28, 2016

Mark Gallant is representing Wills Eye Hospital in its federal lawsuit seeking to overturn a U.S. Department of Health and Human Services decision that says Wills does not qualify as a hospital under Medicare.

Five Cozen O’Connor Lawyers Named 2017 “Lawyers of the Year” by Best Lawyers in America®

August 16, 2016

Cozen O’Connor is proud to announce that five of the firm’s lawyers have been recognized as “Lawyers of the Year” in their respective practices by The Best Lawyers in America, one of the oldest and most highly regarded peer-review publications in the legal profession.

Sixty-Two Cozen O’Connor Lawyers Named to the Best Lawyers in America

August 15, 2016

Sixty-two Cozen O’Connor lawyers from 13 of the firm’s national offices have been selected for inclusion in the 2017 edition of The Best Lawyers in America.

Cozen O’Connor Earns Client Recognition in 2016 Chambers USA Rankings

May 27, 2016

Chambers USA recognized 41 Cozen O’Connor lawyers as leaders in their respective fields; 12 attorneys were recognized nationally and 11 were ranked in the top band.

Mark H. Gallant Discusses CMS Rule (RIN 0938-AQ54; CMS-2328-FC) in Bloomberg BNA

October 29, 2015

Mark H. Gallant discusses CMS rule aimed to ensure states pay providers adequate Medicaid rates so that beneficiaries have access to the same providers as the rest of the population.

Fifty-Two Cozen O’Connor Lawyers Named to the Best Lawyers in America

August 17, 2015

The current edition is based on more than five million detailed evaluations by the top lawyers of the country. This list will be included in dozens of city and regional publications in the United States including The Wall Street Journal, The New York Times, and The Washington Post.

Cozen O’Connor Earns Client Recognition in 2015 Chambers USA Rankings

July 06, 2015

Chambers USA recognized 37 Cozen O’Connor lawyers as leaders in their respective fields; 12 attorneys were recognized nationally and 10 were ranked in the top band.

Mark Gallant Quoted in the New York Times Regarding the Impact of a 2012 Argument, and Its Effect on Medicaid Expansion

March 08, 2015

Mark Gallant, co-chair of the firm's Health Care practice group, is quoted in the New York Times in an article discussing the impact of a 2012 argument against the health care law in the supreme court, and how that is effecting current medicaid expansion.

Mark Gallant Discusses Medicaid in Bloomberg Businessweek

January 20, 2015

In an article titled ''Why the Supreme Court's Medicaid Decision Matters,'' Mark Gallant, co-chair of the firm's Health Care Group, comments on Medicaid providers and how a recent Supreme Court hearing could affect issues at the state and federal level.

Jefferson Health System Legal Counsel, Raphaely, Joins Cozen O’Connor as Co-Chair of Health Care Practice Group

July 09, 2014

Cozen O’Connor continues to strengthen its focus on health care with the recent hiring of R. Christopher Raphaely, who will serve as co-chair of the firm’s Health Care Practice Group. Previously deputy general counsel for the Jefferson Health System, and general counsel to the system’s accountable care organization and captive professional liability insurance companies, Raphaely will be resident in the Philadelphia office.

Cozen O’Connor Earns Client Recognition in 2014 Chambers USA Rankings

May 30, 2014

Chambers USA recognized 29 Cozen O’Connor lawyers as leaders in their respective fields; six attorneys were recognized nationally and eight were ranked in the top band. Stanley Sher was named a “Senior Statesman” in the “Transportation: Shipping: Regulatory (outside New York)” industry, for the pivotal role Sher plays in the firm’s continued success in the transportation industry.

Mark Gallant Prevails in Third Circuit ERISA Dispute

May 13, 2014

Mark Gallant, chair of the Health Care Group, was recently mentioned in a Law360 article about his victory on behalf of CardioNet and LifeWatch Services in the 3rd Circuit.

Mark Gallant Discusses How Cardiac Telemetry Manufacturers, CardioNet Inc. and LifeWatch Services Inc., Were Misguided by PA Federal Judge in Law360

January 24, 2014

In an article titled “Cigna Coverage Row Shouldn’t Be Arbitrated, 3rd Circ. Told,” Mark Gallant (Health Care, Philadelphia) discusses how a Pennsylvania federal judge wrongly forced two cardiac telemetry manufacturers to arbitrate their claims that Cigna Health Corp. violated federal pension laws and unfair competition laws when it decided to stop covering the devices. Mark, who’s representing CardioNet Inc. and LifeWatch Services Inc., told a three-judge panel that claims his clients brought against the insurer under the Employee Retirement Income Security Act and for trade disparagement did not fall under the terms of a provision in the contract the companies inked with Cigna requiring that the parties arbitrate any disputes over interpretations of the deal or any alleged breaches.

Mark Gallant and Robert Chu Mentioned in Law360 for Representing the University of Pennsylvania Health System

November 06, 2013

Mark Gallant, chair of the Health Care Practice Group, and Robert Chu, of the Health Care Practice Group, were recently mentioned in a Law360 article for representing UPenn Health Systems.

46 Cozen O’Connor Lawyers Named to The Best Lawyers in America

August 28, 2013

Forty-six Cozen O’Connor lawyers from eight of the firm’s national offices have been selected for inclusion in The Best Lawyers in America. Attorneys were selected based on a rigorous peer-review of more than 4.3 million detailed evaluations. The list will be included in publications such as The Washington Post, Los Angeles Times, and New York magazine.

Mark Gallant Quoted in Law360

July 11, 2013

Earlier this year, Mark Gallant was quoted in a Law360 article titled, "Hospitals Scramble As ACA Gives Patients Pricing Leverage". Mark Gallant, of the Health Care Practice Group, was quoted as saying "The charges are a problem, but they’re also a symptom of another problem, which is the unevenness of the payments and the need to rob Peter because you're not getting paid by Paul,” said Mark H. Gallant, chairman of the health group at Cozen O'Connor". To read more of Mark Gallant’s remarks, as well as the full article, click here.

Mark Gallant Interviewed in Law360

May 31, 2013

In an article titled, "Hospitals Scramble As ACA Gives Patients Pricing Leverage", Mark Gallant of Health Care Group is quoted regarding the costs that uninsured patients may face as hospitals apply a form of "balance billing" to make up for lower reimbursements from insurers and government payors. Gallant was quoted as saying, "The charges are a problem, but they’re also a symptom of another problem, which is the unevenness of the payments and the need to rob Peter because you're not getting paid by Paul"

Cozen O’Connor’s Health Care and Public Strategies Groups Featured in Legal Bisnow

March 07, 2013

Attorneys Mark Alderman, Mark Gallant, Colin Roskey and Howard Schweitzer are highlighted in this article on Cozen O'Connor's growth in the Health Law and Public Strategies Groups.

Mark Gallant Quoted in Of Counsel Management Report

February 01, 2013

Mark Gallant, a member of the firm, and chair of the Health Law practice group, was quoted in Of Counsel: The Legal Practice and Management Report, in an article titled, “Affordable Care Act, Changing Demographic, Consolidation All Fueling Health Care Law.”

Mark Gallant and Iden Martyn featured in Bloomberg BNA's Health Care Daily Report

March 29, 2012

Mark Gallant and Iden Martyn were featured in Bloomberg BNA's Health Care Daily Report article entitled ''Medicare: Court Finds Notice of Deadline Inadequate, Orders Payment of Medical Education Claims.''

43 Cozen O’Connor Lawyers Named to The Best Lawyers in America

February 09, 2011

Forty-three Cozen O’Connor lawyers from six of the firm’s national offices have been selected for inclusion in the 2011 edition of The Best Lawyers in America. Lawyers were selected for inclusion in the 2011 edition based on a rigorous peer–review of more than 3.1 million detailed evaluations.

Forty-Two Cozen O’Connor Attorneys Honored as Best Lawyers in America

September 29, 2009

Forty-two Cozen O’Connor attorneys from seven of the firm’s national offices have been selected for inclusion in the 2010 edition of The Best Lawyers in America.

Cozen O’Connor Attorneys Named 2009 Pennsylvania Super Lawyers By Law & Politics

May 28, 2009

Cozen O’Connor is proud to announce that 52 attorneys from the firm’s Philadelphia and West Conshohocken offices have been named 2009 Pennsylvania Super Lawyers by Law & Politics, and will appear in the June 2009 issues of Philadelphia magazine and Pennsylvania Super Lawyers.

Twenty-Five Cozen O’Connor Attorneys Honored As Best Lawyers In America

October 29, 2008

Twenty-five Cozen O’Connor attorneys from six of the firm’s national offices have been selected for inclusion in the 2009 edition of The Best Lawyers in America.

Cozen O’Connor Attorneys Named Pennsylvania Super Lawyers By Law & Politics

May 29, 2008

Cozen O’Connor is proud to announce that 42 attorneys from the firm’s Philadelphia and West Conshohocken offices have been named 2008 Pennsylvania Super Lawyers by Law & Politics, and will appear in the June 2008 issues of Philadelphia magazine and Pennsylvania Super Lawyers.

Health Law Handbook 2018 Edition [Thomson Reuters]

June 22, 2018

Mark Gallant, Robert Chu, and Greg Fliszar all of Cozen O'Connor's Health Law group, co-authored the chapter titled, “Medicaid Managed Care” contained in Thomson Reuters’ newly released Health Law Handbook 2018 Edition.

CMS Approves Medicaid Waiver Requiring “Community Engagement” [Health Law Informer Blog]

January 25, 2018

As a first in the history of the Medicaid program, the Centers for Medicare & Medicaid Services (CMS) approved, on January 12, 2018, Kentucky’s section 1115 waiver application that imposes on many beneficiaries a “community engagement” requirement as a condition of Medicaid eligibility. This is...

CMS Waives Medicaid Retroactive Eligibility for Iowa: Is Your State Next? [Health Law Informer Blog]

December 01, 2017

Since 1973, the Social Security Act has mandated that states provide retroactive Medicaid benefits for three months prior to the individual’s application. SSA § 1902(a)(34). Congress enacted this provision to provide coverage to those lacking knowledge about their Medicaid eligibility and to those...

Top 10 Health Law Issues 2017

January 02, 2017

Mark Gallant discusses the Medicaid outlook for 2017 in the AHLA newsletter AHLA Connections.

Representing Hospitals and Health Systems Handbook [AHLA]

August 01, 2016

Mark Gallant and Ryan Blaney discuss key issues for hospital and health care professionals in the AHLA Representing Hospitals and Health Systems Handbook.

Provider Suits Over Medicaid Rates: How We Got to Where We Are Today and the Shapes of Things to Come [Bloomberg BNA]

May 15, 2015

In an article titled "Provider Suits Over Medicaid Rates," Mark Gallant discusses the recent Supreme Court decision in Armstrong v. Exceptional Child Center, Inc.

Pennsylvania Federal Court Reiterates EMTALA’s Inapplicability to Transfers of “Admitted Patients”

March 03, 2015

On February 23, 2015, the District Court in Baney v. Fick held that a patient’s complications arising from elective surgery do not fall under the purview of the Emergency Medical Treatment and Labor Act, 42 U.S.C. § 1395dd, (EMTALA). See 2015 BL 45710, M.D. Pa., No. 4:14-cv-2393 (Feb. 23, 2015). Plaintiffs, a husband and wife, alleged that the medical team managing Brian Baney’s care at Mount Nittany Medical Center should have immediately arranged for his transport to another hospital when he received an esophageal injury following an elective neurosurgical procedure at Mount Nittany Medical Center, and that the team’s care of Baney amounted to a failure to properly stabilize and properly manage Baney’s injury as required under EMTALA. However, the Baney court (citing to Torretti v. Main Line Hospitals, Inc., 580 F.3d 168, 174-75, 177 (3d Cir. 2009), dismissed the plaintiffs’ EMTALA claim with prejudice because the claim “did not fit within EMTALA’s scope.”

Special (Limited) CMS Offer to Settle Claims on Appeal [Health Law Informer Blog]

September 03, 2014

With little fanfare just before the Labor Day weekend, CMS announced a program in which it would enter into administrative agreements with eligible providers in exchange for the providers’ withdrawal of pending appeals (“Settlement Process”). This announcement follows massive backlogs in...

Hospitals Prevail in Effort to Include Pennsylvania GA Days in the Medicare DSH Calculation [Health Law Alert]

April 23, 2013

Two of Mercy Health System’s hospitals (Nazareth Hospital and the former St. Agnes Medical Center) successfully challenged, before Judge Ludwig of the U.S. District Court for the Eastern District of Pennsylvania, the Secretary of Health and Human Services’ exclusion of days of care provided to Pennsylvania’s General Assistance (GA) patients in fiscal year 2002 from the formula used to determine the hospitals’ Medicare disproportionate share hospital (DSH) payments (Nazareth Hosp. v. Sebelius, E.D. Pa. No. 2:10-cv-03513-EL, April 8, 2013). The exclusion resulted in lower Medicare DSH payments.

Seventh Circuit Rules that Medical Necessity Trumps State-Imposed Cap on "Optional" Medicaid Coverage [Health Law Alert]

October 24, 2012

Seventh Circuit Rules that Medical Necessity Trumps State-Imposed Cap on "Optional" Medicaid Coverage - Health Law Alert - In a class action lawsuit, the U.S. Court of Appeals for the 7th Circuit recently affirmed a lower court decision granting a preliminary injunction that prevented the state of Indiana from enforcing a $1,000 annual cap on Medicaid coverage for medically necessary dental services, and concluded the cap most likely violated rights granted to Medicaid beneficiaries under federal law. Bontrager v. Indiana Family and Social Services Administration, 2012 U.S. App. LEXIS 20157 (September 26, 2012).

Supreme Court Upholds ACA's Individual Mandate, But Limits Scope of Medicaid Expansion [Health Law Informer Blog]

July 05, 2012

In a heavily anticipated landmark ruling, the Supreme Court has upheld the constitutionality of the so-called “individual mandate” of the Affordable Care Act – i.e., the requirement that those not insured privately, through their employer or through a governmental program, must either purchase...

Supreme Court Rules on Affordable Health Care Act: Upholds Individual Mandate and Limits Scope of Medicaid Expansion [Health Law Alert]

June 28, 2012

Supreme Court Rules on Affordable Health Care Act: Upholds Individual Mandate and Limits Scope of Medicaid Expansion - Health Law Alert - In a heavily anticipated landmark ruling, the Supreme Court has upheld the constitutionality of the so-called “individual mandate” of the Affordable Care Act – i.e., the requirement that those not insured privately, through their employer or through a governmental program, must either purchase minimum essential health insurance coverage or pay a “penalty” for failing to do so.

CMS Issues Proposed Rule on Reporting and Returning Medicare Overpayments [Health Law Alert!]

February 21, 2012

CMS Issues Proposed Rule on Reporting and Returning Medicare Overpayments - Health Law Alert! - On February 16, 2012, the Centers for Medicare & Medicaid Services (CMS) issued a widely anticipated proposed rule (the proposed rule) implementing the statutory requirement of Section 6402(a) of the Affordable Care Act (the ACA) that providers and
suppliers report and return overpayments from Medicare and Medicaid.

On First Anniversary, a Look at Challenges to Health Care [The Legal Intelligencer]

March 23, 2011

On First Anniversary, a Look at Challenges to Health Care - The Legal Intelligencer - On its one-year anniversary, the sweeping health care reform law — referred to as the "Affordable Care Act" (ACA) if you like it, and "Obamacare" if you don't — is embroiled in litigation. Its fate, like that of the 2000 presidential election, is likely to be determined by the Supreme Court.

CMS Voluntary Self-Referral Disclosure Protocol: The Good, The Bad, and The Ugly [Health Law Alert!]

November 17, 2010

CMS Voluntary Self-Referral Disclosure Protocol: The Good, The Bad, and The Ugly - Health Law Alert! - On September 23, the Centers for Medicare & Medicaid Services (CMS) released the much anticipated Medicare self-referral disclosure protocol (SRDP). CMS was required to establish the SRDP by Section 6409 of the Affordable Care Act (ACA), which obligated the Secretary of Health and Human Services to inform providers and suppliers how to self-disclose actual or potential violations of the Stark law.

Stark Realities of Health Care Reform [Health Law Alert!]

May 12, 2010

Stark Realities of Health Care Reform - Health Law Alert! - Our Health Law Alert of April 26, 2010 summarized recent amendments to the Anti-Kickback Statute (“AKS”) concerning “reverse” federal false claims act (“FCA”) and the implications of the requirement of Section 6402 of the Patient Protection and Affordable Care Act of 2010, Pub. L. No. 111-148 (the “PPACA”) to report and refund “overpayments” by Medicare and Medicaid within sixty (60) days of “identification.” An “overpayment” is defined to

Health Care Reform Includes Reporting Requirements Regarding Drug and Device Manufacturers' Payments to Physicians and Teaching Hospitals [Health Law Alert!]

May 11, 2010

Health Care Reform Includes Reporting Requirements Regarding Drug and Device Manufacturers' Payments to Physicians and Teaching Hospitals - Health Law Alert! - The Patient Protection and Affordable Care Act (the “PPACA”) of 2010 as amended by the Health Care and Education Reconciliation Act of 2010 (the “Reconciliation Act”) (collectively referred to as “the Health Care Reform Act”) includes a number of new reporting requirements designed to enhance the transparency of certain segments of the health care industry including manufacturers of drugs, medical devices, biologicals and medical supplies.

Providers Beware: Health Care Reforms Make Failing to Promptly Refund Overpayments—Including Those Attributable to Identified Stark Violations—Potential False Claims Act Violations [Health Law Alert!]

April 26, 2010

Providers Beware: Health Care Reforms Make Failing to Promptly Refund Overpayments—Including Those Attributable to Identified Stark Violations—Potential False Claims Act Violations - Health Law Alert! - By linking the retention of program overpayments and potential liability under the False Claims Act (FCA), the Patient Protection and Affordable Care Act of 2010 (PPACA) has dramatically expanded the scope of exposure for health care providers under the FCA. Potential overpayments to providers—including but not limited to such things as garden variety duplicate payments to discoveries of Medicare payments for designated health services (DHS) provided on referrals from

Highmark, Inc. Challenges PA. Insurance Department Investigation [Health Law Alert!]

March 23, 2010

Highmark, Inc. Challenges PA. Insurance Department Investigation - Health Law Alert! - Highmark, Inc. has filed a lawsuit in the Commonwealth Court of Pennsylvania challenging the legality of an ongoing Pennsylvania Insurance Department investigation involving potential anticompetitive conduct and/or unfair trade practices by Pennsylvania’s Blue Cross and Blue Shield companies.

New Jersey Enforces Limits on Overpayment Recoveries [Health Law Alert!]

July 09, 2009

New Jersey Enforces Limits on Overpayment Recoveries - Health Law Alert! - The New Jersey Commissioner of Banking and Insurance
issues Enforcement Notice requiring Insurer to cease and
desist from attempting to recoup overpayments based on
improper extrapolations and to reimburse providers for
amounts improperly obtained.

Recent Pennsylvania Decision Requires Disclosure of Medicaid Managed Care Rates [Health Law Alert!]

July 07, 2009

Recent Pennsylvania Decision Requires Disclosure of Medicaid Managed Care Rates - Health Law Alert! - Commonwealth Court holds that provider agreements with
Medicaid managed care plans, including the negotiated
payment rates contained in those agreements, are subject to
disclosure under the Pennsylvania Right to Know Law.

Update: Pennsylvania Hospitals to Pay For Medical Mistakes – Quality of Care At The Forefront [Health Law Alert!]

February 04, 2008

Update: Pennsylvania Hospitals to Pay For Medical Mistakes – Quality of Care At The Forefront - Health Law Alert! - Prevention of medical mistakes is a cause celebre, and states are beginning to jump
on the so-called “never event” bandwagon. Taking a highly proactive stance,
Governor Edward G. Rendell recently announced that Pennsylvania acute-care
general hospitals will not be reimbursed by the state Medicaid program for services
resulting from medical errors. On January 14, 2008, Pennsylvania became just the

HIGHLIGHTS OF THE DEFICIT REDUCTION ACT OF 2005 [Health Law E-lert!]

February 23, 2006

HIGHLIGHTS OF THE DEFICIT REDUCTION ACT OF 2005 - Health Law E-lert! -

PBI Health Law Institute	Philadelphia, PA	03/13/2018
Medicaid Expansion: Yesterday, Today and Tomorrow	Baltimore, MD	03/15/2017
23rd Annual Health Law Institute	Philadelphia, PA	03/07/2017
7th Annual Health Law Year in Review	Philadelphia, PA	12/07/2016
American Health Lawyers Association's Institute on Medicare and Medicaid Payment Issues	Baltimore, MD	04/13/2016
PBI 22nd Annual Health Law Institute	Philadelphia, PA	03/15/2016
AHLA's Institute on Medicare and Medicaid Payment Issues	Baltimore, MD	03/25/2015
PBI's 21st Annual Health Law Institute	Philadelphia, PA	03/12/2015
Health Law Year In Review	Philadelphia, PA	12/03/2014
Institute on Medicare and Medicaid Payment Issues	Baltimore, MD	03/26/2014
PBI 20th Annual Health Law Institute	Philadelphia, PA	03/13/2014
Health Law Year in Review	Philadelphia, PA	02/06/2014
2013 ACC Annual Meeting	Los Angeles, CA	10/27/2013
Managed Care Disputes & Litigation	Philadelphia, PA	05/09/2013
Institute on Medicare and Medicaid Payment Issues	Baltimore, MD	03/20/2013
PBI 19th Annual Health Law Institute	Philadelphia, PA	03/12/2013
Implementing The Affordable Care Act - Countdown to 2014	Philadelphia, PA	02/06/2013
Developments Under the Affordable Care Act in the Wake of National Federation of Independent Business v. Sebelius	Live Webcast	11/05/2012
U.S. Supreme Court Decision on the Affordable Care Act: Assessing the Impact for Pennsylvania Hospitals	Webinar	07/16/2012
AHLA Institute on Medicare and Medicaid Payment Issues	Baltimore, MD	03/28/2012
PBI 18th Annual Health Law Institute	Philadelphia, PA	03/13/2012
17th Annual Health Law Institute	Philadelphia, PA	03/15/2011
Health Law Forum: 2010 Year in Review	Philadelphia, PA	02/08/2011
The Patient Protection and Affordable Care Act and the Stark Law: New Rules, New Challenges	Webinar via Internet	10/14/2010
Medicare Part A Reimbursement: the PRRB and Beyond	Philadelphia, PA	09/21/2010
The Patient Protection and Affordable Care Act of 2010: Key Fraud and Abuse, Compliance and Program Integrity Implications for Hospitals	Webinar	09/16/2010
Navigating Health Care Reform: Challenges for Insurers and Providers	New York, NY	06/23/2010
The New Federal Health Care Law: Issues For All Of Our Practices	Philadelphia, PA	05/26/2010
16th Annual Health Law Institute	Philadelphia, PA	03/11/2010