Skip to main content
Keeping you afloat amidst the rising sea of regulations

Three Critical IT Risks to Avoid in Mergers

*This article was originally published by Healthcare Business & Technology

Where did I put my key (money)?: If It’s Not in the Lease It’s not Enforceable

* The following alert was originally published in California Healthcare News (CHN). To read it on the CHN website, click here.

The FTC Scores Another Win on Appeal of Hospital-Physician Practice Merger Injunction

The Federal Trade Commission (FTC) has proven yet again that antitrust enforcement is alive and well in the health care market. On February 10, 2015, in this most recent win for the federal enforcement agency, the US Court of Appeals for the Ninth Circuit affirmed the FTC’s injunction against St. Luke’s Health System and a large physician group in Idaho. In St. Alphonsus Medical Ctr. – Nampa Inc., et al. v. St.

HHS Announces Big Push on Value-Based Purchasing: Can Congress Take This Over the Finish Line?

The Department of Health and Human Services (HHS) announced last week that, over the next four years, it plans to shift half of its traditional fee-for-service Medicare payments to those that create value through better coordinated care. The idea of value-based purchasing is not a new one. Approximately 3,500 hospitals have been receiving bonuses or penalties as part of Medicare’s 10-year effort to link payments to improved quality in the inpatient setting.

Health and Human Services Sets Goals for Quality-Based Payment Models

In a meeting with almost two dozen health care leaders on January 26, 2015, Health and Human Services (HHS) Secretary Sylvia M. Burwell outlined the clear goals and timelines for moving the Medicare program towards quality-based payments, from quantity or fee-for-service payment models. According to HHS, the purpose of these goals is to ultimately improve patient lives by spending health care dollars more wisely.

HHS Solicits Industry Feedback on Safe Harbors

On December 30, 2014, the Department of Health and Human Services Office of Inspector General (OIG) published its annual solicitation for the development and/or modification of safe harbor provisions under the Federal Anti-Kickback Statute. The OIG also requested recommendations for the development of new OIG Special Fraud Alerts (SFAs). The deadline to submit comments to the OIG pursuant to the solicitation is March 2, 2015.

Last Chance: New Way for Hospitals to Participate in the CMS Settlement Offer for Inpatient Claims

In an effort to encourage hospitals to take advantage of the 68 percent settlement offer for previously denied inpatient claims, [1] the Centers for Medicare and Medicaid Services (CMS) recently announced a new procedure. Hospitals that are unable to produce the required list of claims eligible for settlement by October 31, 2014 (this Friday), may instead submit a request to CMS for a list of potentially eligible claims (a “potentials list”).

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).

Hospitals Face Important Decision on Whether to Accept CMS Settlement Offer for Certain Claims on Appeal

Hospitals Can Settle Certain Claims Now for 68 Percent of Their ValueThe Centers for Medicare and Medicaid Services (CMS) recently announced a policy1 allowing acute care and critical access hospitals to settle inpatient-status claims currently on appeal in exchange for a partial payment equal to 68 percent of the claims’ net allowable amount. The claims eligible for the settlement are those that were billed on an inpatient basis but, according to Medicare contractors (particularly the RACs), should have been billed as outpatient or inpatient Part B claims.

Amendments to Reform ‘Burdensome’ Medicare Regulations Now Effective

On July 11, 2014, amendments designed to reform Medicare regulations that the Centers for Medicare and Medicaid Services (CMS) has identified as “unnecessary, obsolete, or excessively burdensome on health care providers and suppliers” became effective.