Day Pitney’s Healthcare Law Blog provides regular updates on issues affecting all aspects of the healthcare industry. In this era of ever-increasing regulation, we monitor healthcare news and developments from all federal and state agencies, as well as significant court decisions and public policy initiatives. We cut through the jargon and give our clients and other readers what they need to know in a concise, no-nonsense style to save them time while helping them stay informed.

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Crunching the Numbers: The Sentencing Guidelines and Healthcare Fraud

Date: August 13, 2018 | Posted: Daniel E. Wenner | Topics: Fraud and Abuse; Litigation; Medicare and Medicaid; Reimbursement Matters; White Collar

In United States v. Mehmood, the Sixth Circuit affirmed the conviction of Zafar Mehmood and Badar Ahmadani but vacated their sentences and remanded for resentencing. The two were tried and convicted for participation in a massive healthcare fraud scheme that entailed paying kickbacks and obtaining payment from Medicare for fictitious patients.

Reports: Horizon Skewed Quality, Costs on New Plan

Date: August 07, 2018 | Posted: Day Pitney | Topics: Hospitals and Institutions; Litigation; Private Insurers; State Matters

Day Pitney’s Michael Furey was quoted in an July 24 article, "An inside look at how Horizon used hospital costs – and quality – in plan to change N.J. health care," which was published on NJ.com and also appeared in the July 29 edition of The Star-Ledger under the headline "Reports: Horizon Skewed Quality, Costs on New Plan." The article focused on confidential reports and related documents obtained by Advance Local Media, publisher of The Star-Ledger, in connection with a lawsuit brought by three New Jersey-based hospitals alleging that Horizon Blue Cross Blue Shield of New Jersey breached its obligations by limiting its selection of Tier 1 hospitals to the largest hospital systems.

California’s Dreaming of Tougher Health-Care Privacy

Date: August 03, 2018 | Posted: Day Pitney | Topics: Electronic Health Records; Legislation and Public Policy; Privacy and Data Protection; State Matters

An August 2 article in Bloomberg Law's Health Law & Life Sciences News, "California’s Dreaming of Tougher Health-Care Privacy," discussed the California Consumer Privacy Act, a new law that gives consumers the right to know how much of their personal data is being collected by companies and the right to have that data deleted upon request, among other provisions. Day Pitney's Eric Fader was quoted in the article.

CMS Proposes Reimbursement for New Virtual Services

Date: July 30, 2018 | Posted: Eric D. Fader | Topics: Legislation and Public Policy; Medicare and Medicaid; Reimbursement Matters

The proposed rule released on July 12 by the Centers for Medicare & Medicaid Services (CMS) would create new billing codes that, if approved, will reimburse physicians for certain virtual interactions with patients. In addition, telehealth services that are already covered by Medicare would be expanded to include prolonged preventive services.

CMS Proposes Simplified E/M Reimbursement

Date: July 29, 2018 | Posted: Eric D. Fader | Topics: Legislation and Public Policy; Medicare and Medicaid; Reimbursement Matters

The Centers for Medicare & Medicaid Services’ (CMS’s) proposed rule containing revisions to the Medicare Physician Fee Schedule for 2019, released on July 12, proposed a simplified payment system for patient evaluation and management (E/M) services. The proposal would replace the existing five Medicare reimbursement levels for both new and existing patient visits with a single payment rate for each.

Help Wanted: Medicare Looking for Health Tech Expert

Date: July 25, 2018 | Posted: Day Pitney | Topics: Electronic Health Records; Legislation and Public Policy; Medicare and Medicaid

A July 24 article in Bloomberg Law’s Health Law & Life Sciences News, “Help Wanted: Medicare Looking for Health Tech Expert," discussed a new push by Medicare to drive health information technology strategy, as evidenced by a recent announcement by the Centers for Medicare & Medicaid Services (CMS) that it is looking to hire its first-ever Chief Health Informatics Officer (CHIO). The new officer will be responsible for setting CMS’s strategy for encouraging the use of electronic health records (EHRs) and the widespread exchange of healthcare records among providers, health plans, and patients, known as interoperability. Day Pitney’s Eric Fader was quoted in the article.

Support Grows for Stark Law Modification or Repeal

Date: July 20, 2018 | Posted: Eric D. Fader | Topics: Fraud and Abuse; Legislation and Public Policy; Medicare and Medicaid; Reimbursement Matters

There has been a recent groundswell of support for modifying or eliminating the federal physician self-referral law, commonly known as the Stark Law. Last month’s Request for Information by the Centers for Medicare & Medicaid Services (CMS), seeking public comment, was the most prominent example. However, the wave of changes and proposed changes began slowly picking up steam a few years ago, with some changes to Stark going into effect on January 1, 2016.

Private Lawsuit Under HIPAA Dismissed

Date: July 19, 2018 | Posted: Eric D. Fader | Topics: Electronic Health Records; HIPAA and the HITECH Act; Legislation and Public Policy; Litigation; Privacy and Data Protection; State Matters

A recent federal court lawsuit by a private individual accusing Laboratory Corporation of America (LabCorp) of violating the Health Insurance Portability and Accountability Act was dismissed, confirming the well-established premise that HIPAA does not establish a private right of action for violations. This result must be distinguished from recent cases brought under various states’ laws in which HIPAA was deemed to establish a general standard of care for healthcare providers.

Physicians and Teaching Hospitals Received $8.4 Billion in Payments in 2017

Date: July 06, 2018 | Posted: Erin Healy | Topics: Affordable Care Act; Fraud and Abuse; Legislation and Public Policy; Life Sciences; Medical Devices; Medicare and Medicaid; Pharmaceuticals

On June 29, the Center for Medicare & Medicaid Services (CMS) published data summarizing payments made by drug and medical device companies to physicians and teaching hospitals during the 2017 Open Payments program year. Payments disclosed through the Open Payments program are represented in three categories: (i) research payments, which includes payments and transfers of value made in connection with a formal research agreement, (ii) physician ownership, which includes information about ownership or investment interests physicians or their immediate family members have in the reporting entities, and (iii) general payments, which includes payments or transfers of value that are not in connection with a research agreement or protocol.

Confidential Documents Suggest Horizon Misled Public on How it Picked Hospitals for OMNIA Program

Date: June 29, 2018 | Posted: Day Pitney | Topics: Hospitals and Institutions; Litigation; Private Insurers; State Matters

A June 27 article in The Star-Ledger and on NJ.com, "Confidential documents suggest Horizon misled public on how it picked hospitals for OMNIA program," discussed confidential reports and related documents that have been obtained in connection with a lawsuit brought by three New Jersey-based hospitals against Horizon Blue Cross Blue Shield of New Jersey. Day Pitney’s Mike Furey was quoted in the article.

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