Recent News:
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.
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Cozen O'Connor offers a full array of services to major players in the health industry, including hospitals, health care systems, providers and suppliers, device manufacturers, health care entrepreneurs, academic medical institutions, and physician groups. With a national reputation as the go-to firm for payer disputes, we represent clients in high-stakes health industry litigation, including False Claims Act cases, government investigations and large-scale disputes with private payers. Our regulatory and transactional experience is similarly broad, encompassing privacy and HIPAA/HITECH issues; Medicaid, Medicare, and third-party reimbursement; accountable care organizations and pay for value payment arrangements; provider-payer relations; Medicare Secondary Payer Act guidance; provider-based issues; physician-vendor relationships and Physician Payment Sunshine Act; mergers, acquisitions, restructurings, joint ventures, and co-management arrangements; tax, bankruptcy, and antitrust matters; and all manner of health care transactions.
All our work in the health field is grounded on one attribute: a deep knowledge of the governing body of law, including the Medicare and Medicaid statutes and implementing regulations and commercial third-party payer law. Health is such a heavily regulated industry that no matter what the client’s goal may be – consolidation of two health care systems, launch of an MRI facility, challenge to a Medicaid underpayment, or compliance with complex regulatory requirements – the difference between success and failure often turns on mastery of the complex, ever-changing statutory regime, and judgment made possible by decades of industry experience.
The health law team at Cozen O’Connor is unique in that our attorneys combine statutory knowledge with hands-on practicality. Our job, after all, is not to produce doctoral theses on the minutiae of every health code. Instead, it is to provide accurate and concise advice that helps clients achieve their goals. That means using our regulatory experience to secure maximum reimbursements, limit liabilities, and complete transactions efficiently and profitably.
To do that, our health lawyers must be creative. In this confined legal space, one filled with dead ends, narrow passageways, and low ceilings, our talent lies in finding new routes through the maze. Cozen O’Connor’s attorneys are nationally recognized for their ability to identify uncommon legal solutions to seemingly intractable problems. They have successfully reached negotiated solutions in highly contentious litigation matters, achieved favorable results in litigation and designed innovative transactional models that have been adopted by lawyers in other firms.
Our health clients also benefit enormously from the professional relationships our attorneys have with officials in key regulatory bodies, including the Centers for Medicaid & Medicare Services, Department of Justice, state attorneys general offices, state departments of welfare, and state and federal legislatures. We have earned the respect of government administrators over decades of practice. This enables us to reach out to officials to resolve potential issues before they crystallize, and it gives us valuable insight into regulators’ priorities.
SERVICES
Litigation
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Handle a broad array of third-party payer litigation and arbitration matters
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Represent clients in Provider Reimbursement Review Board proceedings
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Respond to fraud and abuse and Stark Law claims, including making strategic decisions about disclosures and other repayments
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False Claims Act representation
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Conduct internal investigations and respond to government investigations
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Defend health care clients in enforcement actions brought by federal and state agencies
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ERISA coverage disputes
Regulatory
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Advise on privacy, security, and other HIPAA/HITECH-related compliance issues
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Counsel clients on Medicare, Medicaid, and other third-party reimbursement matters
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Counsel clients on state and federal Anti-Kickback issues and Stark and Codey issues
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Develop and assess compliance programs
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Counsel clients on Medicare Secondary Payer compliance
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Counsel health care providers and institutions on licensure and certification requirements
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Develop programs to comply with the Physician Payment Sunshine Act
Transactional
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Represent clients in health care mergers, acquisitions, divestitures, and restructurings
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Structure joint ventures and co-management arrangements
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Structure accountable care organizations (ACOs), clinically integrated networks (CINs), and pay for performance arrangements
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Identify and resolve antitrust, tax, and bankruptcy issues for health care organizations
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Arrange financing for assisted living facilities, hospitals, and nursing homes
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Structure contracts between MCOs, third-party payers, and plan administrators
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Develop integrated delivery systems
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Structure relationships between hospitals and medical staff
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Form physician practice groups and physician practice management organizations
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Provide counsel on Medicaid intergovernmental transfers (IGTs) and certified public expenditures (CPEs)
CLIENTS
Our clients include a full range of nonprofit and for-profit health care organizations:
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Health care systems
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Hospitals
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Nursing homes and senior living facilities
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Hospital, nursing home, and pharmacy trade associations
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Accountable Care Organizations and Clinically Integrated Networks
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Physician groups and physician practice management companies
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Academic medical centers
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Entrepreneurs
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Home health and home care companies
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Suppliers
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Device manufacturers and suppliers
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Mental health providers
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Pharmacies
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Banks, financial institutions, and entities involved in the financing of health care enterprises
TEAM
Cozen O’Connor’s health law team has stellar legal, professional, and academic qualifications. The group's co-chairs include the former deputy chief counsel to the Centers for Medicare & Medicaid Services overseeing all federal litigation under the Medicare and Medicaid programs and the former deputy general counsel to the largest health system in Southeastern Pennsylvania. The team includes attorneys with graduate degrees in public health, business, and health care administration and the practice is ranked in Chambers and Partners USA. Team members regularly author scholarly articles and speak about cutting-edge health law issues to a wide variety of audiences.
A notable feature of Cozen O’Connor’s health care practice is its collegiality. This directly benefits clients because it means that colleagues are aware of each other’s skills and can leverage the group’s collective experience to respond to client matters. Health law is also well integrated into the larger firm, and the culture of collaboration extends beyond the practice group. The health law team is backed by top practitioners in labor and employment, insurance, bankruptcy, real estate, corporate, and litigation who have experience handling matters in the health care space. We understand that most problems are multidimensional, so our attorneys work together to devise comprehensive solutions.
October 19, 2017
Renè Quashie, of Cozen O'Connor's Health Care practice, published an article for the American Bar Association about the National Quality Forum's recent publication.
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October 17, 2017
Thomas Dye discusses Restrictive covenants in an employment contract and what employers and employees should know about the laws that govern their agreements.
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October 16, 2017
In moves that stunned and alarmed insurers, providers, and consumers alike, on October 12, the White House issued an announcement and an Executive Order that appear to be purposefully designed to decimate the Health Insurance Marketplace (Exchange) under the ACA:
The White House announced that...
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September 28, 2017
René Quashie, of Cozen O'Connor's Health Care practice, wrote about the current state of Telemedicine in a new chapter of E-Health, Privacy, and Security Law.
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September 06, 2017
State telehealth parity laws, which generally require private payers (and occasionally Medicaid programs) to cover telehealth services if those services would be covered if provided in-person, have long been trumpeted as a means to increase telehealth acceptance. The argument is simple: given how...
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July 12, 2017
2017 is setting records for the funding of digital health emerging companies according to two recent reports. Two leading digital health stakeholders StartUp Health and Rock Health published separate reports in the last two weeks highlighting the record number of digital health deals, total...
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June 15, 2017
The National Quality Forum (“NQF”) has published a draft report (“Report”) recommending various methods to measure the use of telehealth. By way of quick background, NQF is a non-profit, nonpartisan organization that seeks national collaboration to improve health and healthcare quality through...
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May 09, 2017
A recent telemedicine industry benchmark survey published by REACH Health provides great insight into where the industry has been and where it is headed. The survey was conducted among U.S. healthcare executives, physicians, nurses and other professionals. Organizations represented in the survey...
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April 12, 2017
Yesterday the Department of Health (DOH) released the much anticipated proposed temporary regulations for physicians that among other items, set forth requirements regarding: the physician registry, the completion by physicians of a four-hour training course, and issuing patient certifications, as...
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April 01, 2017
Rene Quashie, a member of Cozen O'Connor's Health Care practice, discusses telemedicine in Digital Health Legal.
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March 28, 2017
With the House GOP pulling the American Health Care Act (AHCA) due to lack of sufficient support even within its own party, Obamacare is not out of the woods.
The ACA's two pillars, the individual marketplaces and Medicaid expansion, remain vulnerable and could be used as political bargaining...
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March 28, 2017
Aaron Krauss, a member of Cozen O'Connor's Commercial Litigation department, discusses what to do when doctors can't heal themselves in the ABA Health Law Litigation Section.
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March 23, 2017
The U.S. District of Minnesota has ruled in Peterson v. Unitedhealth Grp. Inc., No. 14-CV-2101 (PJS/BRT), 2017 WL 991043 (D. Minn. Mar. 14, 2017) that ERISA does not permit United Healthcare (“United”) to claw back alleged overpayments related to patients from one plan by reducing or eliminating...
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March 22, 2017
How to properly evaluate and weigh cost savings in health care has long been a controversial subject—perhaps nowhere more so than when technology-enabled health care is evaluated. A recent study is a case in point. The journal Health Affairs recently published a study that has caused quite a stir in...
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February 28, 2017
Amidst all the interesting legal and regulatory issues implicated by telemedicine, one issue less discussed is the potential liability exposure associated with telemedicine. Many critics have argued that the nature of how telemedicine services are provided will naturally lead to increased risk for...
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February 17, 2017
Telemedicine is now mainstream. Surprisingly, however, one area in which telemedicine has not been used to its fullest capability is drug addiction treatment. As you are aware, the country is in the midst of an addiction crisis. The statistics are daunting:
Drug overdose is the leading cause...
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February 16, 2017
Over the past year, the Federation of State Medical Boards (FSMB) and the American Telemedicine Association (ATA) have published documents regarding telemedicine that shed some new light on how state regulatory bodies view telemedicine. Taken together, the documents are generally cause for optimism...
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January 23, 2017
Hours after taking the oath of office President Donald Trump signed a broadly worded executive order (“Order”) intended to minimize if not eliminate the impact of the ACA's least popular provisions. With the Order President Trump can claim immediate action towards fulfilling a major campaign pledge...
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January 23, 2017
On January 17, 2017, the Pennsylvania Department of Health (“DOH”) released grower/processor and dispensary permit applications (“Applications”), which can be found on Pennsylvania’s Medical Marijuana Program website. DOH will accept Applications from February 20 – March 20, 2017, and will begin...
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January 02, 2017
Mark Gallant discusses the Medicaid outlook for 2017 in the AHLA newsletter AHLA Connections.
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December 23, 2016
Word spread quickly Monday (December 20, 2016) about CMS’ issuance of final regulations (to be published in the Federal Register on January 3, 2017) rolling out new mandatory bundled payments models for Acute Miocardial Infarction (AMI), Coronary Artery Bypass Graft (CABG), Surgical Hip and Fracture...
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November 18, 2016
This analysis provides insight into some of the most pertinent business issues President-elect Trump will likely address during his term, and what the election could mean for your industry and your business.
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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.
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June 10, 2016
Aaron Krauss, a member of Cozen O'Connor's Health Care practice, discusses health law litigation based on contract and government claims in a book published by the American Bar Association.
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June 10, 2016
Katherine Layman, J. Nicole Martin and Dana Petrillo co-authored a chapter in An Introduction to Health Law Litigation Based on Contract and Government Claims.
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September 16, 2015
Hospitals and nursing homes may find themselves pulled into union elections or collective bargaining with staffing agencies, outside service providers and hitherto independent contractors.
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July 07, 2015
Ahaviah Glaser discusses the history of disability rights law, the major employment barrier addressed by the Transition to Independence Act, what it might take for this bill to become law and what will be necessary to address problems the disabled face more broadly.
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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.
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March 16, 2015
While one part of the Affordable Care Act, exchange subsidies, hangs in the balance with the Supreme Court’s upcoming decision in King v Burwell, CMS is moving forward aggressively with the evolution of a less controversial ACA-created innovation, the Medicare ACO.
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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.”
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February 28, 2015
Ryan Blaney, a member in the firm's health care practice, contributes to the ABA Health Care & Pharmaceuticals Committee's Recent Developments, which contains summaries of recent federal and state court cases, government enforcement actions, and other “recent developments” involving antitrust and privacy issues in the health care and pharmaceutical industries.
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December 31, 2014
Ryan Blaney, a member in the firm's Washington, D.C. office contributes to the OIG's summary of new and ongoing reviews and activities that OIG plans to pursue with respect to HHS programs during the current Fiscal Year and beyond.
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August 15, 2013
On July 29, 2013, the Office of Inspector General of the U.S. Department of Health and Human Services released a memorandum report finding that Medicare paid more on average for short inpatient stays than for observation stays in 2012. The report, Hospitals' Use of Observation Stays and Short Inpatient Stays for Medicare Beneficiaries, touches on the hot button issue of observation versus inpatient status, which has led to at least one class action lawsuit.
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May 29, 2013
The jury determined that Tuomey violated the Stark Law by entering into improper compensation arrangements with specialist physicians and that the hospital violated the FCA by submitting 21,730 claims to the Medicare program (worth more than $39 million) that were tainted by improper provider referrals.
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May 07, 2013
The Internal Revenue Service issued proposed regulations addressing the requirement under Section 501(r)(3) of the Internal Revenue Code that tax-exempt hospitals conduct community health needs assessments. The proposed regulations also provide details on related reporting obligations and the consequences of noncompliance with CHNA.
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April 30, 2013
A variety of patent issues arise from the act’s Biologics Price Competition and Innovation Act.
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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.
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April 08, 2013
Over the years, the Office of Federal Contract Compliance Programs (OFCCP), which enforces affirmative action and equal opportunity regulations for federal contractors and subcontractors, has tried to assert jurisdiction over hospitals that provide medical care to federal employees in various controversial ways. For example, OFCCP has claimed hospitals are federal subcontractors when they provide medical services to Blue Cross/Blue Shield and/or HMO policyholders pursuant to the insurance providers’ agreements with the Office of Personnel Management (OPM). The U.S. District Court for the District of Columbia just gave the green light to OFCCP to assert its jurisdiction over hospitals, at least where HMOs covering federal employees are involved.
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March 07, 2013
On January 25, 2013, the Office of Civil Rights (OCR) of the Department of Health & Human Services (HHS) published the long-awaited omnibus final regulation governing health data privacy, security and enforcement (Omnibus Rule). The Omnibus Rule is a group of regulations that finalizes four sets of proposed or interim final rules, including changes to the Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Rules mandated by the Health Information Technology for Economic and Clinical Health (HITECH) Act and proposed in 2010; changes to the interim final breach notification rule; modifications to the interim final enforcement rule; and implementation of changes to the Genetic Information Nondiscrimination Act of 2008 (GINA). The Omnibus Rule goes into effect on March 26, 2013, and compliance is required by September 23, 2013. As expected, the Omnibus Rule did not finalize the May 31, 2011 proposed regulation regarding accounting for disclosures.
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January 28, 2013
Under the Affordable Care Act, a number of significant tax increases go into effect in 2013 and other tax provisions will be implemented during the next several years.
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January 25, 2013
The countdown to the 2014 implementation of the Affordable Care Act (ACA) has begun. Each week, administrative decisions, guidance, rules and regulations are coming from the federal and state governments to make ACA a functioning health care system for the 21st century.
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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).
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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.
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June 21, 2012
Federal Court Sends Mixed Message on Hospital's Right to Payment for Out-of-Network Services - Health Law Alert - Hospitals seeking reimbursement from a Medicaid managed care organization (MCO) for non-contracted services, and without the benefit of a single case agreement, need a legal basis to compel payment by the MCO.
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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.
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October 14, 2011
The Medicare Secondary Payer Act - CMS Provides Initial Guidance on Medicare Set Asides in Liability Settlements - Health Law Alert! - On September 30, 2011, CMS, for the first time, issued guidance on the use of Liability Medicare Set-Aside Arrangements (LMSAs) related to liability insurance settlements and judgments (the Guidance)¹. The absence of any formal direction from CMS on the handling of LMSAs has been a significant hindrance in settlement discussions, and even though this Guidance is relatively limited, it is nonetheless helpful
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April 01, 2011
After a two month delay, the Federal Trade Commission (FTC) and Department of Justice (DOJ), acting jointly, and the Center for Medicare & Medicaid Services (CMS) released proposed regulations for Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program (the Program). The Program was created pursuant to the Affordable Care Act and was intended to encourage health care providers to better work together to lower costs and improve patient outcomes.
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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.
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December 12, 2010
House Judiciary Hearing Provides Few Answers for ACO Participants - Health Law Alert! - At the recent House Judiciary Committee’s hearing on the effects of antitrust laws in the heath care industry, testimony relating to accountable care organizations (ACOs) was plentiful, but unrevealing. Industry representatives and federal antitrust enforcers agreed that ACOs have the potential to successfully lower costs and improve quality of care, but government witnesses declined to provide a roadmap as to how ACOs may avoid running afoul of the antitrust laws.
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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.
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November 16, 2010
CMS Delays Section 111 Reporting for Liability Insurers - Health Law Alert! - the Centers for Medicare & Medicaid Services (CMS) announced a one-year delay in the implementation of certain reporting obligations under Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 for claims involving liability insurers (including self-insured entities). Claims involving workers’ compensation and no-fault insurance, however, must be reported as scheduled in the first calendar quarter of 2011. The net result is a two-tiered implementation timeline.
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October 26, 2010
The Medicare Secondary Payer Act and Its Impact on Litigation - The Legal Intelligencer - The Medicare Secondary Payer Act (MSP Act) was first enacted in 1980; however, it is the recent Section 111 reporting requirements (that become effective Jan. 1, 2011, for settlements entered into on or after Oct. 1, 2010) that have brought that statute to the forefront of personal injury and insurance defense litigation. Because liability settlements that include Medicare beneficiaries now have to be reported to the
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October 18, 2010
DOJ Follows Through on Pledge; Sues BCBS of Michigan Over MFN Clauses - Health Law Alert! - The U.S. Department of Justice filed an antitrust lawsuit today against Blue Cross of Michigan alleging that “most favored nation” clauses (“MFNs”) in its hospital contracts violate §1 of the Sherman Act because they serve to raise hospital prices, prevent other insurers from entering the marketplace, and discourage hospitals from providing discounts to other insurers. DOJ seeks to have MFNs between Blue Cross and hospitals declared illegal, to
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August 03, 2010
Proposed New Rules Implementing HITECH Amendments to HIPAA Make Significant Changes - Health Law Alert! - On July 14, 2010, the Department of Health and Human Services (“HHS”) issued a Notice of Proposed Rulemaking (the “Proposed Regulations”) to modify certain regulations that implement the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”). Specifically, the Proposed Regulations implement statutory amendments to HIPAA’s Privacy, Security, and Enforcement Rules made by the Health Information Technology for Economic and Clinical Health Act (“HITECH”),
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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
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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.
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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
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April 19, 2010
Medicare Secondary Payer Update - CMS Delays Reporting Deadlines - Health Law Alert! - In December 2007, Congress amended the Medicare Secondary Payer law (MSP) through Section 111 of the Medicare, Medicaid and SCHIP Extension Act (MMSEA). The amendment imposes mandatory reporting obligations on Responsible Reporting Entities (RREs), including liability, self-insured, no-fault and workers’ compensation insurers (collectively referred to as “non-Group Health Plans” or “Non-GHPs”) regarding settlements with Medicare beneficiaries.
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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.
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February 09, 2010
Under New Rules, Plans Offering Mental Health and Substance Use Disorder Benefits Must Ensure Parity in Member Costs and Access to Care - Health Law Alert! - On February 2, 2010, the Centers for Medicare &
Medicaid Services, the Internal Revenue Service,
and the Department of Labor’s Employee Benefits
Security Administration published long-awaited regulations implementing the Mental Health Parity and Addiction Equity Act of 2008 (the “MHPAEA”).1 The MHPAEA followed the Mental Health Parity Act of 1996, which had previously mandated parity in aggregate lifetime and annual dollar limits between mental health benefits and medical/surgical benefits.
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January 18, 2010
A New Era in HIPAA Enforcement: Connecticut Attorney General Files First HITECH Act Suit - Health Law Alert! - Connecticut Attorney General Richard Blumenthal has filed a lawsuit against Health Net of Connecticut, Inc. for violations of the Health Insurance Portability and Accountability Act (“HIPAA”) following Health Net’s loss of protected health information (“PHI”) and other personally identifiable information.
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August 07, 2009
FTC Again Delays Enforcement of Red Flags Rule - Health Law Alert! - On July 29, 2009, just three days before the effective date of the "Red Flags Rule" (the "Rule"), the Federal Trade Commission ("FTC") announced that it would again delay enforcement of Rule from August 1, 2009 until November 1, 2009. The FTC delayed enforcement to allow it to further educate small business and health care providers about the Rule and what they need to do to comply with its requirements
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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.
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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.
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May 08, 2009
Red Flags Rule Enforcement Delayed...Again - Health Law Alert! - On April 30, 2009, the eve of the effective date of the “Red Flags Rule,” the Federal Trade Commission (FTC) announced that it would again delay enforcement of the Rule until August 1, 2009 in order to allow organizations more time to develop and implement written identity theft
prevention programs. The FTC also announced plans to release a template to help entities that have a low risk of identity theft, such as businesses that know their customers personally, comply with the law
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April 28, 2009
New Medicare Secondary Payer Requirement: Mandatory Reporting for Liability, No-Fault and Workers Compensation Insurers - Health Law Alert! - The Medicare Secondary Payer law (“MSP”) is again “in the news” for liability (including self-insured), no-fault, and workers compensation insurers. In December 2007, Congress amended the MSP law through Section 111 of the Medicare, Medicaid, and SCHIP Extension Act to impose mandatory reporting requirements on liability, no-fault, and workers’ compensation insurers (collectively referred to as “non-Group
Health Plans” or “Non-GHPs”)
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March 20, 2009
The American Recovery and Reinvestment Act of 2009: New Markets Tax Credits Increased by $3 Billion - Health Law Alert! - The American Recovery and Reinvestment Act of 2009
increased the tax credits available under the New
Market Tax Credit program (the “Program”) by $3
billion. The Program provides tax credits to investors or lenders who provide funding to businesses that are primarily located in, derive their income from, and perform services within a low-income community.1 The tax credits allow an
investor or lender to get a 39% tax credit over the first 7 years of the investment,
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March 03, 2009
The American Recovery and Reinvestment Act of 2009: Sweeping Changes to HIPAA Put Business Associates in the Spotlight - Health Law Alert! - On February 17, 2009, President Obama signed into law the Health Information Technology for Economic and Clinical Health Act (“HITECH” or the “Act”), as part of the American Recovery and Reinvestment Act of 2009. The Act made
sweeping changes to the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) and the Privacy and Security Rules promulgated under HIPAA. This Alert focuses
primarily on Subtitle D of HITECH, which includes important
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February 27, 2009
New Codey Legislation to Provide Certainty After a Year of Limbo - Health Law Alert! - On February 5, 2009, the New Jersey legislature
adopted Assembly Bill No. A1933 (the “Bill”), which
amends the New Jersey Health Care Practitioner
Self-Referral Law (commonly referred to as the “Codey Law”).
The Senate adopted an identical bill (S. 787) on December 15,
2008. The Bill currently awaits Governor Corzine’s signature.
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January 01, 2009
Patent-Tailored Medicine, Part Two: Personalized Medicine and the Legal Landscape - Journal of Health & Life Sciences Law - In Part One, the authors addressed the relevance of genetic information, and how race and genetics have affected and may impact the development of medicines, pharmacogenomics, and personalized medicine in the United States. Part Two examines current and proposed federal and state laws and regulations intended to protect individuals from the misuse of genetic information, including uses that discriminate based on genetic...
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October 27, 2008
FTC Delays Enforcement of Red Flags Rule - Health Law Alert! -
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October 01, 2008
HHS' First Resolution Agreement for Alleged HIPAA Violations and What it Means for You - Health Law Alert! - The Department of Health and Human Services
(“HHS”) has entered into its first resolution
agreement with a covered entity to settle alleged
violations of the Health Insurance Portability and Accountability Act’s (“HIPAA”) privacy and security rules.1 According to HHS, the resolution agreement with Providence Health & Services (“Providence”), a Seattle-based not-for-profit health system, addresses a series
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June 23, 2008
Supreme Court Weighs in on Scope of False Claims Act - Health Law Alert! - A recent, unanimous decision of the U.S. Supreme Court appears significantly to reduce the
potential liability under the False Claims Act for claims health care providers file with private Medicare and Medicaid managed care organizations, as opposed to with the Medicare and Medicaid fee-for-service programs. Allison Engine Co. v. United States ex rel. Sanders, 553 U.S.___ (No. 07-214, June 9, 2008).
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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
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September 25, 2007
Pending Changes to the Stark Law Phase III - Health Law Alert - On September 5, 2007, the Centers for Medicare & Medicaid Services (CMS)
published its long-awaited Phase III regulations regarding the federal ban on
physician self-referrals, more commonly known as “Stark.” CMS claims that the
Phase III Stark regulations, effective on December 4, 2007, will reduce the
regulatory burden on the health care industry, “simplify” the rules and provide
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March 20, 2007
SURVEY AND ENFORCEMENT IN LONG TERM CARE - Leadership Health Care Spring 2007 Conference -
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March 20, 2007
HIPAA – Current Issues & Implications for Nursing Homes - Leadership Health Care Spring 2007 Conference -
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March 20, 2007
Litigation - Leadership Health Care Spring 2007 Conference -
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March 20, 2007
Compliance Issues – Fraud and Fraud and Abuse - Leadership Health Care Spring 2007 Conference -
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March 20, 2007
Medicare & Medicaid Issues - Leadership Health Care Spring 2007 Conference -
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January 01, 2007
Internet Prescribing: It’s Fast and Easy, But Is It Legal? - ANDREWS LITIGATION REPORTER - The Internet pharmacy industry is booming and apparently will only get bigger, unless, that is, the federal government decides that prescriptions written without a face-to-face meeting between the physician and patient are invalid. Given its recent enforcement efforts, the government may well be headed in that direction.
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September 01, 2006
Using Mental Health Records for Research - Compliance Today - The Health Insurance Portability and Accountability Act’s Privacy Rule (the “Privacy Rule”) strikes a balance between restricting the unauthorized disclosure of medical records and permitting health care providers to operate effectively, including participation in research studies. Specifically, the Privacy Rule takes into account that getting patient authorization for a disclosure can be problematic for researchers who do not interact directly with
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August 08, 2006
The Deficit Reduction Act of 2005 Imposes New Obligations On Medicaid Providers By January 1, 2007 - Health Law E-lert! -
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February 23, 2006
HIGHLIGHTS OF THE DEFICIT REDUCTION ACT OF 2005 - Health Law E-lert! -
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