SCOTUS Decides Implied Certification Issue in Key False Claims Act (Whistleblower) Case

In a decision that is poised to have resonating implications for health services providers, the Supreme Court of the United States explicitly endorsed the “implied false certification theory of liability” under the False Claims Act (FCA) in Universal Health Services, Inc. v.  U.S. ex rel. Escobar.  Under this theory of liability, any person who submits a claim for payment or reimbursement from the Federal Government impliedly certifies that they have complied with all applicable statutory, regulatory, and contractual requirements upon which payment is materially conditional, and any failure to disclose a violation of such applicable underlying legal obligations is considered a misrepresentation rendering the claim “false or fraudulent” under the FCA. 

Are you a business that has had a data breach? Will your customers be able to sue you?

Class actions for damages resulting from a data breach are difficult to succeed upon unless there is an identifiable harm.  Once again a court has determined that the mere loss of data is not sufficient to confer standing (Chambliss v. CareFirst, Inc.,  No. RDB-15-2288 [D. MD., May 27, 2016]).  With the decision in Chambliss, Maryland […]

USDA Offers Funding for Healthcare Providers Serving Rural Areas

Rural healthcare providers that seek funding for capital expenditures, equipment, vehicles, or telemedicine infrastructure for their programs should make themselves aware of special funding opportunities through the United States Department of Agriculture. The three programs of immediate interest to rural healthcare providers are: (1) the Community Facilities Direct Loan & Grant Program; (2) the Community […]

OCR Announces that the Phase 2 HIPAA Audit Program Has Already Started

The HHS Office for Civil Rights (OCR) just announced that its Phase 2 HIPAA audit program has started and that covered entities and business associates are already being contacted. You can find this announcement here. OCR has begun sending emails to verify contact information for various covered entities and business associates and determine which entities […]

ATTENTION ALCOHOLISM AND SUBSTANCE ABUSE SERVICES PROVIDERS: SAMHSA’s Proposed Changes to 42 CFR Part 2 Address Key Integration Issues, Raise Other Questions About Compliance Responsibilities

In an earlier post, we highlighted that the federal Substance Abuse and Mental Health Services Administration (“SAMHSA”) submitted a proposed rule for public comment in the February 9, 2016 edition of the Federal Register, see 81 FR 6988, proposing a number of changes to 42 CFR Part 2 (“Part 2”), the federal regulations governing the […]

N.Y. Appellate Division Upholds Insurance Policy Exclusion for “Five Guys” Data Breach

Today, the New York State Supreme Court, Appellate Division, Third Department issued a decision enforcing an insurer’s exclusion of coverage for “damages arising out of the loss of . . . electronic data,” stemming from a 2011 credit card data breach at certain locations of the Five Guys Burgers & Fries restaurant chain. The decision should prompt businesses, especially […]

Further Analysis of 60-day Medicare Overpayment Rule Reveals Emphasis on Proper Compliance Plans

Last week, we highlighted that the Centers for Medicare and Medicaid Services (“CMS”) released a long-awaited final rule regarding its interpretation of the statutory obligation of Medicare Part A and Part B providers to return any overpayments they receive from the program within 60 days after such an overpayment is “identified.”  The final rule is […]

CMS Releases Final Rule on 60-day Medicare Overpayment Reporting Obligations

This morning, the Centers for Medicare and Medicaid Services (“CMS”) made available a copy of a final rule clarifying the obligations of providers and suppliers to report and return Medicare overpayments within 60 days after the date on which the overpayment was identified.  The final rule will be published in tomorrow’s Federal Register.

O&A Offers Healthcare Payment Cycle and Financial Consulting for Challenging Markets

In the post-recession world of tighter credit, the close management of payment cycles, accounts receivable, payables, debt and financing obligations, and cash flow has become even more critical to maintaining healthy businesses. Management of these issues also impacts the successful start-up of new practices, facilities or acquisitions.  While these issues apply equally to healthcare market, […]