Health Care Law Blog

New Long Term Care Regulations Impose Requirements for Provider Contracts

The Centers for Medicare & Medicaid Services ("CMS") has recently proposed the much anticipated Long Term Care regulations related to Hospice Services.  These proposed rules mirror the hospice regulations that went into effect on December 2, 2008, and establish requirements that facilities must meet in order to qualify to participate in the Medicare and Medicaid programs.  Specifically, the proposed rules obligate Long Term Care facilities to (1) enter into an agreement with a Medicare-certified hospice to arrange for the provision of hospice services to residents, or (2) assist in transferring residents to a facility that will arrange for the provision of hospice services when requested by the residents.  If an arrangement between a Long Term Care facility and Hospice is established, CMS has also strictly regulated the content of the agreements between the two.  Traditionally, the content of such agreements receives significant attention and scrutiny from surveyors.

If you would like assistance in drafting new agreements or reviewing your current contracts to ensure compliance with the proposed rules, please contact one of the experts in Foster Swift's Health Care Practice Group. 

Categories: Compliance, Regulatory

Posted by: Mindi M. Johnson

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New Blue Cross Class Action Lawsuit Implicates Hospitals

On January 21, 2011, the City of Pontiac filed a class action lawsuit against Blue Cross Blue Shield of Michigan ("Blue Cross") and 21 hospitals and health systems (collectively, the "Hospital Defendants").  The complaint alleged that Blue Cross unlawfully restrained trade in violation of the Sherman Act and Michigan Antitrust Reform Act by including 'most favored nation' ("MFN") clauses in its contracts with hospitals.  (The effect of these clauses was to allegedly raise the minimum prices that hospitals could charge to Blue Cross' competitors.) Read More ›

Categories: Billing/Payment, Hospitals

Posted by: Mindi M. Johnson

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New Medicare Screening Requirements for Providers

In conjunction with a step-up in other fraud and abuse enforcement activities, CMS recently announced new screening procedures, which will be applicable to newly enrolling providers and suppliers as well as to providers and suppliers who are currently enrolled in Medicare, Medicaid and CHIP who revalidate their enrollment information.  Read More ›

Categories: Fraud & Abuse, Medicare/Medicaid, Regulatory

Posted by: Jennifer B. Van Regenmorter

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Red Flags Program Clarification Act of 2010 Passed to Exempt Healthcare Providers from Red Flags Rule

The Red Flags Rule requires "creditors" to address the risk of identity theft by implementing and updating identity theft programs that identify, detect, and respond to potential identity theft problems.  While the definition of "creditor" under the  Red Flags Rule was previously broad enough to include healthcare providers, the recently passed Red Flag Program Clarification Act of 2010 (the "Act") narrowed the definition of "creditor" to include only entities that use consumer reports or furnish information to consumer reporting agencies or to others who extend credit.

The Act, therefore, exempts doctors, dentists, orthodontists, pharmacists, nurse practitioners, and other healthcare providers from the Red Flags Rule.  This is timely news as compliance with the Red Flags Rule is set to begin on December 31, 2010.

Categories: Compliance, Regulatory

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