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Keeping you afloat amidst the rising sea of regulations

OIG Issues New Guidance for Health Care Boards

On April 20, 2015, the US Department of Health and Human Services Office of Inspector General (OIG), the Association of Healthcare Internal Auditors (AHIA), the American Health Lawyers Association (AHLA), and the Health Care Compliance Association (HCCA) jointly released an educational resource for governing boards (Boards) titled Practical Guidance for Health Care Governing Boards on Compliance Oversight (Compliance Oversight Guidance).

Partner Lowell Brown Quoted by Bloomberg BNA’s Health Law Reporter about Top Health Care Legal Issues in 2015

Arent Fox Health Care partner Lowell C. Brown was quoted several times in an article in Bloomberg BNA’s Health Law Reporter. The article outlined legal issues that health care providers can expect to face in 2015. The list included hospital/physician alignment, health information and technology, antitrust, fraud and abuse, health plan regulation, Medicaid, Medicare, corporate governance, and licensure.

What the 2014 Election Means for Your Industry

The 2014 midterm Congressional elections have resulted in a significant wave of victories for the Republican Party that confers new majority status in the US Senate and expands the majority in the US House of Representatives. A new two-year era of divided government will begin on January 3, 2015 but there are reasons to believe that the election results could lead to new opportunities for Congressional action in the coming months on pressing issues.

UPDATE: CMS Provides New Guidance to Hospitals on How to Settle Inpatient Appeals

Representatives for the Centers for Medicare and Medicaid Services (CMS) held a conference call on October 9, 2014 to address ongoing questions and clarify the requirements for hospitals that want to settle the inpatient-status claims whose denials they have appealed. As discussed in a recent Arent Fox client alert,1 the CMS settlement offer will pay hospitals 68 percent of the amount at issue.

Government Gives Health Care Companies More Leverage in Their Negotiations with Physicians

Recent Cases Demonstrate Potential Exposure for Both Physicians and ProvidersHealth care organizations that contract with physicians can face potential liability (including millions of dollars in civil, criminal, and administrative penalties), as well as exclusion from participation in federal health care programs, under various laws (such as the Stark Law), the anti-kickback statute, and the False Claims Act (FCA).

Medical Emergency Teams Can Recoup Their Costs by Reducing Adverse Events

Studies analyzing the cost-effectiveness of certain medical practices can sometimes indirectly suggest other, seemingly-unrelated benefits to a health care organization’s bottom-line. Such is the case in a study (Study) of medical emergency teams (MET) published in Pediatrics (“Cost-Benefit Analysis of a Medical Emergency Team in a Children’s Hospital,” Pediatrics 2014; 134; 235 (Aug. 2014)).

The Department of Justice’s New Focus Could Place Health Care Executives at Risk

The US Department of Justice (DOJ) periodically makes statements announcing changes in its planned approach to prosecuting corporations generally. As attorneys for health care providers, we pay close attention to those statements because they often are of particular interest to our clients. On September 25, 2014, Law360 published an article by Arent Fox partner Peter R. Zeidenberg that addresses just that type of DOJ statement.

OIG Finds Commercial Drug Copay Coupons Are Being Used by Medicare Part D Beneficiaries and Warns of Anti-Kickback Statute Exposure

On September 19, 2014, the Department of Health and Human Services Office of Inspector General (OIG) released a Special Advisory Bulletin (SAB) in tandem with the results of an OIG report entitled “Manufacturer Safeguards May Not Prevent Copayment Coupon Use for Part D Drugs” (Report on Copay Coupons) reinforcing the government’s position that the provision of cost-sharing assistance or “coupons” by pharmaceutical manufacturers to or for use by federal health care program beneficiaries implicates the federal Anti-Kickback Statute (AKS).