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The Legal Stuff
BT Health Law Blog
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15 Jan 2016 Hospitals Mount Another Challenge to the CMS “2 Midnights” Policy and Reductions in Reimbursement Rates

  On Jan. 8, 55 general acute care hospitals from 19 different states filed suit against U.S. Department of Health and Human Services (HHS) Secretary Sylvia Matthews Burwell.   The suit alleges that the Centers for Medicare & Medicaid Services’ (CMS) decision to institute a 0.2 percent decrease in hospital payment rates from FY 2014 through FY 2018 violated the Administrative Procedure Act (APA) because the rule was finalized without following proper notice and comment procedures. The plaintiffs’ further allege that the rule was arbitrary,…

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14 Jan 2016 Illinois Appellate Court Rules Hospital Tax Exemption Law Unconstitutional

  Last week, in a unanimous ruling, the Illinois Appellate Court for the Fourth District declared that a state law granting property tax exemptions to hospitals was unconstitutional. The Fourth District’s ruling could have ramifications for a number of Illinois hospitals, but it remains to be seen whether the decision will be reviewed by the Illinois Supreme Court.   The case originated when a hospital system, after being assessed a tax bill by its local jurisdiction, sought a declaratory judgment from the circuit court that…

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13 Jan 2016 What You May Not Know (But Should) About Voluntarily Surrendering Your DEA Registration

  The scenario is not all that uncommon: Drug Enforcement Administration (DEA) agents or investigators show up at your office as part of a routine audit, administrative inspection or, worse, a criminal investigation. Not having expected the unanticipated visitor, you or your medical office staff feel unprepared, anxious, and perhaps a bit fearful. Eager to resolve any issues so your normal business can resume, when the DEA representative presents you with Form 104 “Voluntary Surrender,” you grudgingly think your best option is to sign it. After all, the DEA…

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12 Jan 2016 How to Differentiate Between a Consultation and Pre-Procedure Encounter

    Physician clinicians commonly interact with their patients before and after their procedures and subsequently bill patients for that time. As with most medical billing, there are guidelines which provide when a physician may bill under an Evaluation and Management Services (E/M) code in addition to the procedure code, and when the physician may only bill one code or the other.   The guidelines advise that if the physician-patient encounter is at the request of another physician and the purpose of the visit is…

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08 Jan 2016 HHS ISSUES NEW HIPAA EXCEPTION FOR REPORTING MENTAL HEALTH INFORMATION TO NATIONAL FIREARMS DATABASE

  On Jan. 6, the Department of Health and Human Services (HHS) issued a final rule adding a new exception to the HIPAA regulations.  The rule allows certain covered entities to report limited information about individuals to the National Instant Criminal Background Check System (NICS), the database maintained by the FBI for conducting background checks, to determine whether an individual is prohibited from possessing firearms.   Continue reading this Barnes & Thornburg publication on our HIPAA Resource Site. Stacy CookStacy L. Cook is a partner…

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05 Jan 2016 IRS Extends Deadlines For Health Plan Information Reporting Under The ACA

The Internal Revenue Service (IRS) recently provided good news to employers struggling to comply with the new Affordable Care Act (ACA) reporting requirements, extending the due dates for 2015 information reporting under Sections 6055 and 6056 of the Internal Revenue Code.   Under the ACA, health insurance issuers, self-insuring employers, and other providers of minimum essential coverage are required to file and furnish annual information returns and statements regarding coverage provided. The ACA also requires applicable large employers – generally those with 50 or more…

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23 Dec 2015 New York Requires Pharmacy Benefit Management Contracts to Include Dispute Resolution Provisions

On Dec. 11, New York State Governor Andrew Cuomo signed Senate Bill 3346-B, requiring contracts between pharmacy benefit managers (PBMs) and pharmacies (or pharmacies’ contracting agents) to include a mechanism for appeals for contract disputes relating to multi-source generic drug pricing.   Pharmacy benefit management contracts must include the following provisions regarding appeals: The right for a pharmacy to appeal for 30 days following an initial claim submitted for payment; A telephone number through which a network pharmacy may contact the PBM for the purpose…

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18 Dec 2015 Supreme Court to Review “Implied Certification” Theory Under the False Claims Act

Earlier this month the U.S. Supreme Court granted certiorari in Universal Health Services v. United States ex rel Escobar, a closely-watched case that addresses the theory of “implied certification” under the False Claims Act. The False Claims Act makes it a crime to submit a false or fraudulent claim to the government for reimbursement. Typically, a false claim arises when a government contractor submits a reimbursement claim for a product or service that was not actually provided.  Additionally, a claim can be considered “legally false”—even…

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17 Dec 2015 Medicare Fraud Strike Force Indicts Chicago-area Home Health Agency Owner

The Medicare Fraud Strike Force (Strike Force) operating in conjunction with the U.S. attorney’s office for the Northern District of Illinois recently indicted the owner and a contractor of Hexagram Home Health Care LLC (Hexagram) based in Harwood Heights.  Jacqueline Tuanqui, the owner of Hexagram, was charged with one count of criminal healthcare conspiracy and eight substantive counts of paying illegal kickbacks. In addition, Susie Avellanosa, owner of Allied Care Services Inc. of Elgin, was correspondingly charged with one count of criminal healthcare conspiracy and…

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03 Dec 2015 ANOTHER STATE (NY) ENFORCES HIPAA – SETTLES CASE WITH HEALTH CENTER

The New York attorney general recently entered into a settlement agreement with the University of Rochester Medical Center (URMC) for HIPAA violations. The enforcement action by New York comes on the heels of a HIPAA enforcement action by the Connecticut attorney general in early November 2015.  Prior to the Health Information Technology for Economic and Clinical Health (HITECH) Act, only the federal government could enforce HIPAA.   In March 2015, a nurse practitioner was preparing to leave URMC for a position at Greater Rochester Neurology (GRN). …

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