Michigan’s Health Insurance Claims Assessment Act is Upheld Once Again
Michigan’s tax on paid health care claims is not preempted by ERISA, according to a decision by the United States Court of Appeals for the Sixth Circuit. On remand from the United States Supreme Court, the federal appellate court held that the Health Insurance Claims Assessment Act does not impermissibly interfere with the uniform administration of group health plans or impose additional burdens on self-insured plans and third-party administrators. Read More ›
Categories: 6th Circuit Court of Appeals, Insurance, News & Events, Tax
Share
OCR Begins Phase 2 Audit Program of Covered Entities and Business Associates
The U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) recently announced that it has begun Phase 2 of its HIPAA audit program. This audit phase will impact covered entities and their business associates. Read More ›
Categories: Compliance, HIPAA, Hospitals, Providers
HHS Issues Final Rule Implementing ACA Nondiscrimination Provisions
The U.S. Department of Health & Human Services ("HHS") recently issued a final rule that implements the nondiscrimination provisions under Section 1557 of the Affordable Care Act (the "Final Rule"). The Final Rule becomes effective July 18, 2016. Read More ›
Categories: Health Care Reform, News & Events, Providers
Sixth Circuit Affirms Dismissal of FCA Whistleblower Lawsuit Based on Health Data Breach
The U.S. Court of Appeals for the Sixth Circuit recently affirmed a district court’s dismissal of a whistleblower lawsuit alleging violations of the False Claims Act based on an individual security breach. The case, United States ex rel. Sheldon v. Kettering Health Network, arose after the relator (or whistleblower) received letters from Kettering Health Network (KHN) informing her that KHN employees, including her now ex-husband, impermissibly accessed her medical records. Read More ›
Categories: 6th Circuit Court of Appeals, Compliance, HITECH Act, Providers
CARE Act Legislation Signed Into Law By Governor Snyder and Set to Take Effect July 12th
The Michigan CARE Act, recently signed into law by Governor Snyder, is set to take effect on July 12, 2016. Michigan becomes the 29th state to enact the CARE Act, which is intended to support and equip family caregivers with information and training when loved ones go into the hospital and as they transition home. A copy of Public Act No. 85 is available here (We have identified that the following link is no longer active, and it has been removed). Read More ›
Categories: Compliance, Hospitals, News & Events
District Court Awards Summary Judgment to AseraCare in $200 Million Hospice False Claims Act Case
On March 31, 2016, the United States District Court for the Northern District of Alabama granted summary judgment for AseraCare in one of the largest False Claims Act (FCA) lawsuits against a hospice provider. In this whistleblower case, the government sought over $200 million, alleging that defendant AseraCare overbilled Medicare for hospice services by falsely certifying that patients were eligible for hospice care.
The litigation began when six AseraCare employees in Alabama, Wisconsin and Georgia (the "relators") filed whistleblower cases under the FCA. The employees alleged that AseraCare knowingly submitted false claims to Medicare by falsely certifying that patients met the Medicare eligibility requirements for the hospice benefit. In order to be eligible for the Medicare hospice benefit, a patient's physician must certify that "the individual's prognosis is for a life expectancy of 6 months or less if the terminal illness runs its normal course." 42 C.F.R. § 418.22(b)(1). The Department of Justice (DOJ) intervened in January 2012. Read More ›
Categories: Audits, Billing/Payment, Medicare/Medicaid, Providers
Recent Seven Figure Settlements Underscore the Importance of HIPAA Compliance, Particularly in Light of OCR’s Announced Increase in Audit Activity
The Department of Health and Human Services (HHS) Office for Civil Rights (OCR) recently announced that it reached resolution agreements and corrective action plans with two health care entities - a health system and a research institution - in connection with alleged violations of the Health Insurance Portability and Protection Act of 1996 (HIPAA). These cases underscore the importance of ongoing HIPAA compliance vigilance by covered entities and business associates, particularly in light of OCR’s recent announcement that it has commenced Phase 2 of its audit program. Read More ›
Categories: Audits, Compliance, HIPAA, Providers
Michigan Health Insurance Claims Assessment Act back for Reconsideration
The Michigan Health Insurance Claims Assessment Act is back for reconsideration before the United States Court of Appeals for the Sixth Circuit. The act imposes a tax on paid health care claims that is used to fund the state share of Michigan’s Medicaid program. The act had been upheld by the federal appeals court in 2014 against an ERISA preemption challenge brought by an organization representing self-insured group health plans and third-party administrators.
The Supreme Court recently remanded the case to the federal court of appeals for reconsideration in light of a decision holding that a Vermont all-payers claim database statute interfered with the uniform administration of ERISA plans and was therefore preempted. Read More ›
Categories: Medicare/Medicaid, Tax
Is Losing Money by Employing Physicians a Stark Violation?
Modern Health Care has reported that hospitals often lose approximately $176,000 a year per each employed physician.
While this initially seems like a surprising statistic, it is understandable that hospitals lose money when they employ physicians. Physicians in private practice often pay their staff less than comparable hospital employees. When a hospital buys a physician’s practice, the benefit costs typically increase if the staff receives the hospital’s fringe benefit package. Moreover, hospital overhead is typically higher than a private physician practice with regard to HR costs and other support services.
Many systems claim that the only way to manage the health of a given population (which is what ACO and other similar payment structures are requiring) is to be fully integrated with employed physicians, so covering the losses incurred by employing physicians is the necessary cost of preparing for the new paradigm. The ugly, and legally problematic, truth is that most health systems look beyond the income generated by physicians for treating patients but also at income from physician ancillary referrals to justify the economic losses caused by acquiring physician practices. This raises concerns under the Stark law. Read More ›
Categories: Billing/Payment, Compliance, Hospitals, Medicare/Medicaid, Physicians
CMS Issues Final Rule on Reporting and Returning Overpayments
On February 11, 2016, the Centers for Medicare & Medicaid Services (“CMS”) issued its long-awaited Final Rule on Reporting and Returning of Overpayments (the “Final Rule”). The Final Rule, which will become effective on March 14, 2016, implements section 1128J(d) of the Affordable Care Act (“ACA”). This Section of the ACA requires that Medicare providers report and return Medicare overpayments by the later of (A) the date that is 60 days after the date on which the overpayment was identified; or (B) the date any corresponding cost report is due, if applicable (the “60-day rule”). According to CMS, the purpose of the Final Rule is to provide “needed clarity and consistency in the reporting and returning of self-identified overpayments.”
CMS issued a Proposed Rule on Reporting and Returning of Overpayments (the “Proposed Rule”) on February 16, 2012. The Final Rule includes some important changes to the provisions of the Proposed Rule. A summary of the major provisions of the Final Rule appears below. Read More ›
Categories: Billing/Payment, Health Care Reform, Medicare/Medicaid, News & Events
Categories
- HIPAA
- Long-Term Care
- Providers
- Digital Assets
- Employee Benefits
- Medicare/Medicaid
- 6th Circuit Court of Appeals
- Technology
- Fraud & Abuse
- Retirement
- News
- Pharmacy
- Medicare
- Affordable Care Act
- Privacy
- Employment
- Hospice
- Health Care Reform
- Hospitals
- Department of Labor
- Insurance
- Alerts and Updates
- Billing/Payment
- Patents
- Labor Relations
- News & Events
- Workers' Compensation
- Criminal
- HITECH Act
- Lawsuit
- Electronic Health Records
- Physicians
- Regulations
- Legislative Updates
- Regulatory
- Tax
- Medicaid Planning
- Did you Know?
- Audits
- Accountable Care Organizations
- COVID-19 and Workers' Compensation
- Licensing
- Contracts
- Compliance
- Cybersecurity
- Health Insurance Exchange
Best Lawyers® 2021
Congratulations to the attorneys of the Health Care practice group at Foster Swift Collins & Smith, PC for their inclusion in the Best Lawyers in America 2021 edition. Firm-wide, 44 lawyers were listed. Best Lawyers lists are compiled based on an exhaustive peer-review evaluation and as lawyers are not required or allowed to pay a fee to be listed; inclusion in Best Lawyers is considered a singular honor. Health Care practice group members listed in Best Lawyers are as follows:
- Jennifer B. Van Regenmorter, Holland
To see the full list of Foster Swift attorneys listed in Best Lawyers 2021, click here.