CMS Proposes Rule to Make Medicare Data Available for Public Reports About Providers

The Patient Protection and Affordable Care Act (“PPACA”) requires that “standardized extracts” of Medicare claims data be made available to “qualified entities” in connection with their preparation of reports evaluating the performance of providers.  Since this information is now “required by law,” these disclosures are allowed under the Health Insurance Portability and Accountability Act’s Privacy […]

HHS OIG Finds Potential Anti-Kickback Violations in Online Referral Service

In an advisory opinion dated May 13, 2011, the Department of Health and Human Services, Office of the Inspector General (“OIG”) warned the operator of an online referral system that charging health care providers a fee to list their services on the system could potentially violate the Anti-Kickback Statute and lead to administrative sanctions, including […]

Arkansas Federal Court Determines that Arbitration Agreement Is Not Prohibited “Other Consideration” under Medicaid Regulations

Medicaid law forbids nursing facilities from requiring “any gift, money, donation, or other consideration” as a precondition of admission to that facility.  See 42 U.S.C. § 1396r(c)(5)(A)(iii); 42 C.F.R. § 483.12(d)(3).  On May 10, 2011, the United States District Court for the Western District of Arkansas ruled that an arbitration agreement as a precondition of […]

Governor Cuomo Announces, and Senate Confirms, the New Public Health and Health Planning Council

Governor Andrew Cuomo announced nominations for the newly established Public Health and Health Planning Council (“PHHPC”) early last week.  The members of the former Public Health Council will be joined by twelve new appointees confirmed by the Senate on Tuesday to create the new Council, consisting of a twenty-four member committee plus the Commissioner of […]

CMS Releases Exceptions to ACO Rules for Rural Areas

The Centers for Medicare & Medicaid Services (CMS) has released a fact sheet titled “Medicare Shared Savings Program and Rural Providers” highlighting exceptions to the proposed regulations governing accountable care organizations (ACOs). On March 31, 2011, CMS released its proposed rules for ACOs. According to CMS, ACOs are supposed to help doctors, hospitals and health […]

US Supreme Court Rules in FCA, FOIA Case

On May 16, 2011 the US Supreme Court resolved a split among federal circuits and ruled in Schindler Elevator Corp. v. United States ex rel. Kirk that a federal agency’s response to a Freedom of Information Act (FOIA) request amounts to a “report” within the False Claims Act’s (FCA) pre-PPACA public disclosure bar and therefore […]

CMS Receives Failing Marks for HIPAA Enforcement

The Office of the Inspector General (OIG) for the U.S. Department of Health and Human Services (HHS) released a report on the oversight and enforcement actions conducted by the Center for Medicare and Medicaid Services (CMS) pertaining to hospitals’ implementation of the HIPAA Security Rule.  The OIG conducted its audits at CMS in Baltimore, Maryland, […]

GlaxoSmithKline In-House Attorney Acquitted of Obstruction of Justice Charges; Judge Criticizes Application of Crime Fraud Exception to Privileged Documents

In November 2010, a former in-house counsel for the pharmaceutical company GlaxoSmithKline, Lauren Stevens, was indicted on charges of making false statements and obstructing a federal investigation into illegal drug marketing with regard to the antidepressant Wellbutrin.  The federal investigation surrounded allegations that GlaxoSmithKline had illegally marketed Wellbutrin for weight-loss, a use for which had […]

CMS Reports $162 Million In Medicare Overpayments in First Three Months of 2011

Based on a recent report released by CMS, its Medicare Fee-for-Service Recovery Audit Program recovered $162 million in Medicare overpayments during the period of January through March 2011. This is a substantial increase in the amount of money recovered by the Recovery Audit Program (RAP) in that $162 million is more than double the amount […]

Supreme Court Rejects Virginia’s Request to Fast Track Challenge to PPACA

Yesterday, the United States Supreme Court rejected a request made by the Commonwealth of Virginia to fast track a challenge to the Patient Protection and Affordable Care Act (PPACA) passed last year. When a case is fast-tracked, it bypasses the regular federal appeals process, and the case goes directly to the Supreme Court Justices for review.  […]