New Reporting Requirements under the IMPACT Act for Post-Acute Care Providers

President Obama signed into law on October 6th, 2014 the “Improving Medicare Post-Acute Care Transformation Act of 2014”, also known as the “IMPACT Act of 2014”.  The IMPACT Act of 2014 amends the Social Security Act to require home health agencies, skilled nursing facilities, inpatient rehabilitation facilities, and long-term care hospitals to report on a […]

CMS Issues 2015 Managed Care Rate Setting Consultation Guide

On Wednesday, October 2, the Centers for Medicare and Medicaid Services (“CMS”) issued its  2015 consultation guide for states to use when setting reimbursement rates with respect to any Medicaid managed care program subject to actuarial soundness requirements in 42 CFR 438.6 during rating periods starting January 1, 2015.  The guide “describes information that CMS expects states to provide […]

New Nurse Practitioner Rule on Track

The New York State Education Department (“SED”) issued a proposed rule to allow nurse practitioners (“NPs”) with 3,600 hours of experience to have collaborative agreements with hospitals, as opposed to individual physicians.  We wrote about the amendment to the Education Law in April of this year.  This first notice of proposed rulemaking appears to put […]

Who’s Looking Out for Patients? OIG Recommends more CMS Oversight of Medicaid Managed Care Programs

Office of the Inspector General of the federal Department of Health and Human Services (“OIG”) has issued a report that suggests that most states that offer Medicaid through Managed Care Organizations (“MCOs”) have widely-variable and possibly inadequate oversight of the organizations providing care to Medicaid beneficiaries.  Given OIG’s findings, beneficiaries, providers, and Medicaid MCOs should […]

IOM Provides Support that Focus is Needed on Advance Care Planning

Many studies have been done demonstrating that many individuals have not talked to providers or loved ones about end-of-life care.  However, studies also demonstrate that for individuals who discuss their wishes for decisions to be made at the end-of-life, the individual experiences an increased quality of life and both the individual and family have greater […]

An Ever Widening Gap: Circuit Split on the Applicable Pleading Standard for the False Claims Act

Many areas of the False Claim Act are subject to legal interpretation and have been subject to Circuit splits, sometimes resulting in rulings from the Supreme Court.  In the United States, there are thirteen federal circuit courts that provide intermediate appellate review of the federal district courts in several states.  The decision by a circuit […]

Expanding Their Arsenal: Criminal Prosecution of HIPAA Breaches on the Rise

Over the past year, the Office of Civil Rights (“OCR”) has taken a more aggressive stance in enforcing the provisions of the Health Insurance Portability and Accountability Act (HIPAA).  The largest settlement for a data breach to date was just announced earlier this year between OCR and New York Presbyterian Hospital and Columbia University. However, […]

FDA Seeks to Regulate Laboratory Developed Tests

On July 31, 2014, the Food and Drug Administration (“FDA”) announced that it would begin regulating laboratory developed tests (LDTs).  According to the FDA, LDTs are designed, manufactured, and used within a single lab, and include some genetic tests and tests that are used by various health care professionals.  These tests are developed by hospitals, academic, […]

Absher v. Momence: A Mixed Decision—Limiting and Expanding the False Claims Act

In the ever-expanding area of the federal False Claims Act, the recent decision by the 7th Circuit in Absher v. Momence Meadows Nursing Center Inc., limited pursuing a False Claims Act violation under the worthless services theory but potentially expanded what administrative reports do not trigger the public disclosure bar of the False Claims Act. […]

Cardiology Group to Pay More than $1.33 Million to Settle Allegations of Stark Law and False Claims Act Violations

According to United States Attorney Richard Hartunian of the Northern District of New York, Cardiovascular Specialists, P.C., has agreed to pay the federal government $1,336,636.98 plus interest to settle allegations that it violated the federal Physician Self-Referral Law (also known as the Stark Law) and the federal False Claims Act by knowingly compensating its physicians […]