One of the main concerns that healthcare providers have regarding clinical integration is whether there is an issue with anti-trust law.
Tuomey Healthcare System faces up to $237 million in fines and penalties after a jury found it liable for submitting $39 million worth of claims to Medicare in violation of both the Stark Law and the False Claims Act.
With the passage of the HITECH Act in 2010 and the publication of final rules related to the HITECH Act in January of 2013, parts of HIPAA now apply to entities besides health care organizations.
Adoption of Compliance Plans for all health care providers/suppliers is now mandatory under the Patient Protection and Affordable Care Act Section 6401, if providers are enrolled in federal programs.
In 2008, the Michigan Supreme Court concluded that domestic partnership policies intended to provide health care benefits to same sex couples violated Michigan law. Recently, in Attorney General v Civil Service Commission, the Michigan Court of Appeals upheld a policy providing health care benefits to state employees and "other eligible adult individuals."
Many hospitals and groups of physicians are forming Accountable Care Organizations to cover Medicare fee for service beneficiaries under the Medicare Shared Savings Program. What issues must new ACOs keep in mind in its proceeding to qualify for the MSSP program? This article discusses that question.
The U.S. Department of Health and Human Services Office of Inspector General released its Work Plan for Fiscal Year 2013. Corporate compliance officers should carefully review the portions of the Work Plan applicable to their businesses.
As President Obama moves into his second term, health care reform moves forward with him. Foster Swift has developed guides to aid employers with their preparation efforts. Download these guides here.
It is important for health care providers to understand the litigation process. This article outlines what happens in a lawsuit.
The chart below provides important upcoming dates for employers to consider.
As part of the 2010 Healthcare Reform Act, Code Section 501(r) of the Internal Revenue Code was added to provide that a hospital would lose its tax exemption unless the hospital meets five requirements.
The Internal Revenue Service, Department of Labor and Department of Health and Human Services published final regulations describing the summary of benefits and coverage requirement of the Patient Protection and Affordable Care Act.
The Internal Revenue Service recently released the 2013 health savings account contribution limits, out-of-pocket maximums and high deductible health plan deductibles.
The Internal Revenue Service recently issued guidance regarding the $2,500 limit on salary reduction contributions to a health flexible spending account under the Patient Protection and Affordable Care Act.
Although existing federal law requires medical providers to report and return Medicare overpayments, the Patient Protection and Affordable Care Act imposed a new requirement on the timing for doing so.
The United States Supreme Court issued its long awaited ruling regarding the constitutionality of the Patient Protection and Affordable Care Act. The Supreme Court upheld PPACA, including the individual mandate that requires individuals to obtain health care insurance coverage or pay a penalty.
The "exclusive remedy" provision of Michigan's Worker's Disability Compensation Act does not prevent an individual from bringing a federal Racketeer Influenced and Corrupt Act ("RICO") lawsuit.
In a recent complaint filed in Minnesota against Accretive Health, a business associate was implicated for breach of the Health Insurance Portability and Accountability Act.
One costly problem for Medicaid and Medicare is the inordinate amount of money spent on individuals who are dually eligible for both Medicare and Medicaid. Michigan introduced its solution to this problem in the form of its proposal to "Integrate Care for People Who Are Medicare - Medicaid Eligible ("MMEs")".
In re-credentialing and granting staff privileges to a surgeon with a history of 17 medical malpractice suits, a hospital, through its credentialing committee, could not be found to have proximately caused a patient’s claimed injuries.
How should a medical provider handle a situation where a minor's parent is unavailable to consent to treatment? Several "best practices" in dealing with this situation are covered in this article.
The Patient Protection and Affordable Care Act requires employers to report the aggregate cost of "applicable employer-sponsored health coverage" on each employee's Form W-2 beginning with the 2012 tax year. The Internal Revenue Service has released new guidance regarding this reporting requirement.
On October 20, 2011, the IRS issued a new Fact Sheet that provided additional information for exempt organizations on how their participation in the MSSP through an ACO would be treated by the IRS.
Michigan's Health Insurance Claims Assessment Act was approved by Governor Snyder on September 20, 2011 and given immediate effect.
Michigan's legislature, like 15 other state legislatures, has proposed legislation to create its own insurance exchange.
Effective for the first plan year that begins on or after August 1, 2012 (January 1, 2013 for a calendar year plan), a non-grandfathered group health plan is required to provide certain preventive health services for women.
On September 24, 2011, Governor Snyder signed into law the Publicly Funded Health Insurance Contribution Act.
On September 24, 2011, Governor Snyder signed into law the Publicly Funded Health Insurance Contribution Act.
Hospitals are required to create a community health needs assessment in order to be recognized, or continue being recognized, as a 501(c)(3) entity.
The federal government, through the Health Information Technology for Economic and Clinical Health Act (“HITECH”) is pushing physicians and other health care professionals towards EHR by offering financial incentives and eventually imposing financial penalties.
When it has been appropriately implemented, the Michigan Exchange will play a vital role in opening health care access and insurance coverage for hundreds of thousands of Michigan citizens and their families.
In Henry Ford Health System v. Department of Health and Human Services, the Sixth Circuit Court of Appeals upheld a regulation promulgated by the Secretary of Health and Human Services which excluded from hospitals' Medicare reimbursements the time residents spent conducting pure research.
The DOL recently issued guidance that extends the grace period for amending non-grandfathered group health plans to comply with certain provisions of the new internal claims and appeals procedures.
As employers work to evaluate the impact of the Patient Protection and Affordable Care Act on their workers, insurance needs and balance sheet, many are wondering if and when the PPACA will apply to them.
This article is a follow-up to an earlier article in April where we discussed various issues facing three likely entities that might take the lead in creating an ACO.
The IRS has published guidance that might exempt your business from the new requirement to report the cost of health care on your employees' Forms W-2.
Small employers may soon expect to see provisions in their health plan policies requiring them to make minimum contributions to their employees' premiums as a result of a recent Michigan Supreme Court decision.
The Federal Trade Commission and the Department of Justice's response to Accountable Care Organizations is not surprising: more regulation.
Many are concerned that current fraud and abuse laws would prevent the development of ACOs and their benefits of higher quality medicine and lower costs.
When Section 3022 of the Patient Protection and Affordable Care Act was passed it became clear that in order to establish a Medicare Shared Savings Program, it would take health care practitioners to combine in networks, partnerships or joint ventures with tax-exempt hospitals or health systems to obtain the coverage necessary to achieve the government's goals: higher quality and health care savings.
While the Patient Protection and Affordable Care Act may be a year old, one of the provisions that may have the greatest impact on the health care industry has received hardly any attention from the media or lawmakers.
The U.S. Department of Health and Human Services’ Office for Civil Rights recently imposed a civil monetary penalty of just over $4.3 million against Cignet Health of Prince George’s County in Maryland.
On January 21, 2011, the City of Pontiac filed a class action lawsuit against Blue Cross Blue Shield of Michigan and 21 hospitals and health systems.
The Centers for Medicare & Medicaid Services ("CMS") has recently proposed the much anticipated Long Term Care regulations related to Hospice Services.
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.
Registration for the electronic health record ("EHR") incentive programs with Medicare and Medicaid in Michigan began on January 3, 2011.
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.
Recently published IRS Notice 2011-1 delays the effective date of the Patient Protection and Affordable Care Act's (PPACA) nondiscrimination provisions.
In a recent published opinion, the Michigan Court of Appeals emphatically confirmed the protection against disclosure for credentialing and privileging files maintained by hospitals.
The Drug Enforcement Administration recently issued a policy statement intended to provide guidance regarding the proper role of a duly authorized agent of a DEA-registered individual practitioner in connection with the communication of controlled substance prescriptions to a pharmacy.
All long term care facilities that work with hospices: consider yourselves warned. Surveyors will be coming, scrutinizing your agreements with hospices, and handing out citations for non-compliance.
The grandfathered health plan regulations issued this past summer contained rules for determining when changes to a group health plan would cause the plan to lose its grandfathered status.
Since the issuance of our Fall 2010 Employment, Labor & Benefits Quarterly, the IRS, on October 12, 2011, announced that it will postpone until 2012 the new reporting requirement that employers report the cost of coverage under an employer-sponsored group health plan.
Beginning January 1, 2011, face-to-face certification and recertification visits with home health and hospice patients will no longer be simply good practice.
On July 19, 2010, Michigan Senate Bills 026, 027, and 028 were enacted to allow physician assistants to join professional service corporations and professional limited liability companies with physicians or podiatrists who perform the same professional services that the PA performs.
Thousands of Americans lose health care coverage each year due to rescissions.
The IRS recently issued IRS Notice 2010-59 clarifying the definition of a qualified "medical expense" under the Patient Protection and Affordable Care Act.
Generally, when a physician terminates a relationship with a patient, he or she must be careful to avoid patient abandonment and discriminatory termination claims.
Now, the attainment of these goals is to be the primary focus of so-called state sponsored "Exchanges" administered by a state government agency or non-profit organization.
The new health care reform law, the Patient Protection and Affordable Care Act, makes numerous changes to the tax law, including creating new taxes and credits, increasing other taxes, making insured health benefits taxable to the extent that they are discriminatory, modifying certain deductions, and changing the tax rules that apply to health savings accounts and spending arrangements.
The Patient Protection Portability Care Act requires the distribution of certain notices describing changes that take effect for plan years beginning on or after September 23, 2010.
In a recent decision, the Michigan Supreme Court held that the federal HIPAA medical privacy law does not prohibit ex parte interviews of treating physicians by defense counsel as long as reasonable efforts have been made to secure a qualified protective order.
PPACA provides that certain group health plans and health insurance coverage in existence on March 23, 2010 are subject to only certain provisions of the PPACA.
The Patient Protection and Affordable Care Act, as amended, ushers in a new, much larger dimension of meaning for terms such as "Compliance", "Compliance Plan", "Compliance Program", and the like.
The Affordable Care Act provides that certain group health plans and health insurance coverage existing as of March 23, 2010, are subject only to certain provisions of the Affordable Care Act.
In 2006, Henry Ford Hospital provided medical services to Travion Hamilton for severe injuries that he sustained when a stolen Jeep Cherokee in which he was a passenger struck a utility pole.
A very small section of the Patient Protection and Affordable Care Act (PPACA) makes some major changes in Form W-2 reporting which will impact employers in the near future.
HHS recently issued its first guidance on the topic of drafting a "Risk Analysis."
Early retirees are individuals age 55 and older who are enrolled in a certified employment-based plan, and not eligible for coverage under Medicare.
Section 1558 of PPACA amends the Fair Labor Standards Act by prohibiting discrimination against an employee who...
The Patient Protection and Affordable Care Act as amended ("PPACA") made several changes to cafeteria plans. Some of the most significant changes are summarized below.
While much of the discussion concerning the Health Care Reform Act has addressed private health insurance reforms, there have been significant changes to the Medicare and Medicaid statutes concerning fraud and abuse.
Section 6003 of the health care reform act amends the in-office ancillary service exception under Stark.
On March 30, 2010 the Michigan Court of Appeals clarified the relationship between Notices of Intent and the allegations later allowed in a complaint and eventually presented to a jury.
In U.S. ex rel. Radcliffe v. Purdue Pharma, the Fourth Circuit for the U.S. Court of Appeals enforced a release barring a qui tam action where the government had declined intervention.
If you were wondering whether the COBRA subsidy obligation expired on March 31, 2010, Congress has rather belatedly decided that it hasn't.
Since 1969, hospitals have been able to claim an exemption from federal income taxes under § 501(c)(3) of the Internal Revenue Code ("Code") based upon meeting the "community benefit" standard articulated by Revenue Ruling 69-545.
Congress recently approved an additional extension of the COBRA subsidy eligibility period for certain involuntarily terminated employees.
On February 17, 2010, most of the Health Information Technology for Economic and Clinical Health Act ("HITECH") became binding on the health care industry.
On January 29, 2010, the Department of Labor, the Department of the Treasury, and the Department of Health and Human Services jointly issued interim final regulations for the Mental Health Parity and Addiction Equity Act ("MHPAEA").
On February 17, 2010, most of the Health Information Technology for Economic and Clinical Health Act ("HITECH") becomes binding on the health care industry.
Your patient/client has been accused of child abuse or neglect, and YOU have been served with a subpoena. What do you do now?
On January 21, 2010, the United States Supreme Court ruling in Citizens United v Federal Election Commission ("FEC") reinforced the free speech rights of corporations and labor unions to participate in the political process through independent communications expressly advocating the election or defeat of clearly identified candidates.
Beginning on March 1, 2010, new rules will significantly expand the reporting of adverse information about health care practitioners and entities to the National Practitioner Data Bank.
On December 1, 2009, the Sixth Circuit Court of Appeals upheld a jury's conviction of anesthesiologist Dr. Jorge A. Martinez for mail fraud, wire fraud, health care fraud (including two counts that resulted in the death of patients), and illegally distributing controlled substances.
The Department of Defense Appropriations Act of 2010 (DOD) extends the COBRA subsidy previously created by the American Recovery and Reinvestment Act of 2009.
With regard to health care compliance plans, there are those providers who have done a plan; those who have been forced by the government to have a plan; and those who should have a plan.
On December 19, 2009, President Obama signed the Department of Defense Appropriations Act (DDAA) which contains some major expansions and extensions relating to COBRA premium assistance.
For the second time in the last year, Congress has expanded the scope of the Family Medical Leave Act (FMLA).
On October 28, 2009, President Obama signed into law the Fiscal Year 2010 National Defense Authorization Act (2010 NDAA).
The Federal Trade Commission ("FTC") has further delayed enforcement of the Red Flags Rule until June 1, 2010.
On Wednesday, August 19, 2009, the Department of Health and Human Services ("DHHS") issued new regulations requiring HIPAA covered entities to notify individuals when their health information is breached.
On July 29, 2009 the Michigan Supreme Court overruled portions of previous rulings in Roberts v Mecosta County General Hospital and Boodt v Borgess Medical Center...
Most lawyers, and their clients have historically viewed assets in a retirement plan as “safe” from all but the most highly protected creditors.
The Centers for Medicare and Medicaid Services ("CMS") on July 8, 2009 issued a press release that stated that The Joint Commission has been granted deeming authority for the accreditation of critical access hospitals.
Recent amendments to the State of Michigan False Claims Statute make it more likely for employees (relators) to decline dealing with the federal government and opt towards dealing directly with the State's Attorney General's office.
A recent decision by the Michigan Court of Appeals emphasizes the need for health care professionals and facilities to diligently comply with the statutory duty to report suspected child abuse or neglect.
There has been much discussion during the past several months about the American Recovery and Reinvestment Act ("ARRA") and its impact on COBRA continuation health coverage.
The American Recovery and Reinvestment Act of 2009 contained provisions requiring health care covered entities and business associates regulated by the Health Insurance Portability and Accountability Act to notify certain parties in the event of a breach of unsecured protected health information.
There have been three recent developments in the health care fraud area, one locally and two nationally, that significantly impact enforcement.
In a recent study of patients with advanced cancer, researchers found that “positive religious coping remained a significant predictor of receiving intensive life-prolonging care near death.”
On May 20, President Obama signed into law the Fraud Enforcement and Recovery Act ("FERA") of 2009.
The Federal Trade Commission ("FTC") announced on April 30, 2009, that it will delay enforcement of the new “Red Flags Rule” until August 1, 2009.
Most exempt organizations must file an annual return (Form 990, Form 990-PF or Form 990-EZ) or an annual electronic notice (Form 990-N) depending on the organization's gross receipts and total assets.
The 2009 American Recovery and Reinvestment Act requires a temporary reduction of COBRA premiums for all group health plans that are subject to COBRA.
The 2009 year brought increases in both the federal estate tax exclusion amount and the annual gift tax exclusion amount.
If you wish to participate in such a meeting, HIPAA requires you to ensure certain precautions are in place before you discuss a patient's protected health information.
President Obama recently signed into law Title III of the Children's Health Insurance Program (CHIP), which expands state CHIP (SCHIP) programs.
The American Recovery and Reinvestment Act of 2009 was enacted on February 17, 2009.
In 2008, the Michigan Legislature revised Michigan's Medical Records Access Act to include "heirs at law" in the Act's definition of an authorized representative entitled to obtain copies of a deceased patient's medical records or autopsy reports.
New revisions to the Mental Health Parity Act of 1996 ("Act") take effect on January 1, 2010, for most group health plans.
Medicare oversees a variety of payment systems and a network of contractors that process over 1.2 billion claims each year.
On Friday, December 19, 2008, the Department of Health and Human Services issued a final rule to ensure that federally funded health care providers, including individual physicians and institutional providers, may safely decline to participate in certain health services because of their religious, moral, ethical, or other beliefs.
Advisory Opinion 08-15, issued by the Office of Inspector General...
On October 30, 2008, CMS released the Medicare Physician Fee Schedule Final Rule effective January 1, 2009.
The Michigan Court of Appeals in a 3-0 published opinion ruled that if a qualified protective order consistent with the HIPAA regulations was obtained, ex parte discussions with healthcare providers would be acceptable.
The Federal Trade Commission ("FTC") issued new rules requiring creditors with certain "covered accounts" to have policies and procedures in place by November 1, 2008, to detect, prevent and mitigate identity theft.
On May 7, 2008, the Michigan Supreme Court held that the marriage amendment prohibits public employers from providing health insurance benefits to their employees’ qualified same-sex domestic partners.
The following 16 conditions have to be met for the hospital and the physicians to fit within the new Stark gainsharing exception:
When a patient dies leaving unpaid medical expenses, a health care provider may discover that the patient owned most or all of his or her assets jointly with another individual.
On June 19, 2008, the United State Supreme Court held that an ERISA plan administrator that both evaluates benefit claims and pays the benefits has a conflict of interest that affects judicial review of benefits decisions.
In 2004 Congress enacted Internal Revenue Code ("Code") Section 409A, which dramatically changes the requirements for maintaining nonqualified deferred compensation arrangements.
Ever since the Supreme Court’s decision in Arizona v Maricopa County Medical Society, 457 US 332 (1982), it has been clear that price fixing by competitors is a per se violation of the federal antitrust law.
On May 28, 2008, the Centers for Medicare & Medicaid Services ("CMS") issued an advisory opinion regarding a proposed arrangement where a hospital system would pay a third-party vendor to develop a physician practice interface customized to each affiliated physician practice’s existing electronic health records software.
Any time a patient is treated for injuries suffered in a motor vehicle accident, more likely than not a no-fault automobile insurance company has some obligation to pay related bills.
The Michigan State House and Senate have been considering several pieces of legislation pertaining to Blue Cross Blue Shield of Michigan and individual health insurance contracts.
On April 14, 2008, the Centers for Medicare and Medicaid Services issued proposed changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2009 Rates.
The Department of Health and Human Services Office of Inspector General recently refined its Provider Self Disclosure Protocol for voluntary disclosure of noncompliance with federal health care program requirements.
Earlier this year, President Bush signed into law the National Defense Authorization Act.
The rapid growth of information technology in health care has transformed medical practice in the past decade.
In Roberts v Farmers Ins Exchange, plaintiff, a 12 year old girl involved in a motor vehicle accident, repeatedly cancelled or missed physical and neuropsychological independent medical examinations.
Since the Whistleblower Office was created in December 2006, the IRS has reported that it has received about 80 claims, half of which were submitted in just the last two and a half months of 2007.
Congress, Centers for Medicare and Medicaid services ("CMS") and the Office of the Inspector General have developed and are providing new mantras for quality.
On December 28, 2007, the Office of Inspector General ("OIG") issued Advisory Opinion No. 07 21 involving a group of cardiac surgeons and Advisory Opinion No. 07 22 involving a group of anesthesiologists.
In July 2007, the Centers for Medicare and Medicaid Services ("CMS") issued proposed changes to the 2008 Medicare Fee Schedule.
The Michigan Legislature recently adopted the Public Employees Health Benefit Act...