Topic: General

DOJ Recovers More than $2.6 Billion from Health Care False Claims Act Cases in FY 2019

By Keith Rosen (US) and Chandra Westergaard (US) on January 21, 2020 Posted in Enforcement, General

On January 9, the United States Department of Justice (“DOJ”) announced its statistics on federal False Claims Act cases for FY 2019. In a lengthy press release, the DOJ reported more than $3 billion in settlements and judgments from civil cases involving fraud and false claims against the government. Of this total, the DOJ reported … Continue reading

U.S. Fifth Circuit Court of Appeals affirms the ACA’s individual mandate penalty is unconstitutional and remands the case to the lower court to examine severability

By Jeff Wurzburg (US) on December 19, 2019 Posted in Enforcement, General

On Wednesday, December 18, 2019, the U.S. Court of Appeals for the Fifth Circuit held in Texas v. Azar that the Affordable Care Act’s (ACA) individual mandate is unconstitutional and remanded the case to the lower court for further review. In a split 2-1 panel decision, the Fifth Circuit held that the individual mandate is … Continue reading

AHA Requests 60-Day Extension to Comment Period for CMS’s proposed rule Medicaid Fiscal Accountability Regulation

By Thomas Dowdell (US) on December 17, 2019 Posted in General, News from DC

On December 16, 2019, the American Hospital Association requested a 60-day extension to the comment period for the Centers for Medicare & Medicaid Services’ proposed rule Medicaid Fiscal Accountability Regulation. The proposed rule was published in the November 18 Federal Register and the comment period closes January 17, 2020. The AHA requested an extension in … Continue reading

CMS Publishes CY 2020 OPPS & ASC Price Transparency Requirements Final Rule and Transparency in Coverage Proposed Rule

By Mark Faccenda (US), Jeff Wurzburg (US) and Thomas Dowdell (US) on November 20, 2019 Posted in General, News from DC, Regulatory

On November 15, the Centers for Medicare & Medicaid Services (CMS) published the Calendar Year (CY) 2020 Outpatient Prospective Payment System (OPPS) & Ambulatory Surgical Center (ASC) Price Transparency Requirements for Hospitals to Make Standard Changes Public final rule and the Transparency in Coverage proposed rule. CMS intends through this rulemaking to increase price transparency … Continue reading

CMS Proposes Major Changes in Medicaid Fiscal Accountability Rule

By Jeff Wurzburg (US) and Thomas Dowdell (US) on November 20, 2019 Posted in General, News from DC, Regulatory

On November 12, 2019, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule for public inspection entitled Medicaid Fiscal Accountability Regulation. CMS states that the intent of the proposed rule is to ensure that state supplemental payments and financing arrangements under the Medicaid program are consistent with federal statutory requirements. In a … Continue reading

CMS and OIG release sweeping proposals to modernize Stark Law and AKS regulations

By Joseph Keillor (US) on October 16, 2019 Posted in General, News from DC, Regulatory

On Thursday, October 17, 2019, the Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services (HHS) Office of Inspector General (OIG) will publish in the Federal Register two proposals to implement major changes to Stark Law and Anti-Kickback Statute (AKS) regulations. We have summarized a portion of those proposed … Continue reading

US regulators to align key health care regulations with transformation to value-based care system; CMS and OIG propose major overhaul of Stark Law and AKS regulations

By Thomas Dowdell (US), Debbi Johnstone (US), Stacey Murphy (US) and Benjamin Wallfisch (US) on October 14, 2019 Posted in General, News from DC, Regulatory

On October 9, 2019, the Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services (HHS) Office of Inspector General (OIG) issued two sweeping proposals aimed at revising the Stark Law and Anti-Kickback Statute (AKS) regulations to adapt to and promote the US health care system’s transformation to value-based payment … Continue reading

Medicaid Update: D.C. Circuit Court of Appeals Reviews CMS Approval of Medicaid Work and Community Engagement Eligibility Requirements

By Jeff Wurzburg (US) on October 11, 2019 Posted in General, News from DC, Regulatory

Today, October 11, 2019, the United States Court of Appeals for the D.C. Circuit is hearing oral arguments in Stewart v. Azar (Case No. 19-5095), an appeal from the federal district court’s rulings invalidating three prior approvals of Section 1115 Waivers in Kentucky and Arkansas that would have implemented work and community engagement requirements as … Continue reading

President Trump signs executive order to make changes to Medicare Advantage

By Denise Webb Glass (US) on October 8, 2019 Posted in General, News from DC

On Thursday, October 3, 2019, President Trump signed an executive order that aims to expand the Medicare Advantage program. Medicare Part C, commonly known as Medicare Advantage, is administered by private insurers in which CMS pays the health insurer on a fee per beneficiary basis and the insurer in turn pays providers a negotiated rate … Continue reading

Uber as a HIPAA business associate

By Alexis Wilpon (US) on March 7, 2018 Posted in General

Uber recently announced the launch of Uber Health, a non-emergency ride service that allows healthcare providers to schedule and pay for transportation for their patients. The stated purpose of the service is to expand medical transportation to traditionally underserved areas. Roughly 3.6 million Americans miss medical appointments each year due to lack of reliable transportation, contributing to the … Continue reading

Update on medical assistance in dying: Bill C-14

By on April 20, 2016 Posted in General

Update on Medical Assistance in Dying: Bill C-14 On April 15, 2016, the federal government responded to the Supreme Court of Canada’s decision in Carter v. Canada (Attorney General), 2015 SCC 5 by introducing Bill C-14 into the House of Commons for first reading. While Bill C-14 addresses many of the issues raised by the … Continue reading

Update on physician-assisted dying: A changing medical legal landscape

By Melissa Perry (CA) on March 7, 2016 Posted in General

On February 29, 2016, an Alberta woman suffering from amynotrophic lateral sclerolsis (“ALS”), became the first person in Canada to obtain a physician-assisted death. Four days prior to her death, Ms. S applied to the Alberta Court of the Queen’s Bench and successfully obtained an exemption from the Criminal Code prohibition on physician-assisted dying in … Continue reading

A loophole in the law of contracts? The application of the duty to act honestly

By Melissa Perry (CA) on March 2, 2016 Posted in General

In its recent decision in Burquitlam Care Society v Fraser Health Authority, 2015 BCSC 1343, the British Columbia Supreme Court may have expanded the potential use of the common law duty to act honestly as a means for contracting parties to seek legal recourse against public bodies outside the scope of their contractual rights. (See … Continue reading

Physician-assisted dying part 4: Patient perspectives

By on February 26, 2016 Posted in General

The right to determine what should be done with one’s own body is a fundamental right in our society. In Carter v. Canada (Attorney General), 2015 SCC 5, the Supreme Court of Canada confirmed that, for a competent adult suffering from a grievous and irremediable medical condition, this right includes a right to die with … Continue reading

Physician-assisted dying part 3: Finding a balance between autonomy and access

By Melissa Perry (CA) on February 19, 2016 Posted in General

“Health institutions, including regional health authorities and other institutional providers (e.g. hospitals, hospices and long-term care facilities) are critical enablers of effective and equitable access to physician-assisted dying.” Provincial-Territorial Expert Advisory Group on Physician-Assisted Dying, Final Report, November 30, 2015, at 3. Part 2 of this series examined the implications of the decriminalization of physician-assisted … Continue reading

Physician-assisted dying part 2: Implications for frontline healthcare professionals

By Melissa Perry (CA) on February 5, 2016 Posted in General

“This issue is not one of life or death. The issue is what kind of death, an agonized or peaceful one. Shall we meet death in personal integrity or in personal disintegration? Should there be a moral or demoralized end to mortal life?” Fletcher, J. (1954). Morals and Medicine. Princeton, NJ: Princeton University Press at … Continue reading

CMS revisits ACO benchmarking

By Jim Wiehl (US) and Joseph Keillor (US) on February 1, 2016 Posted in General, Regulatory

CMS issued a proposed rule on January 28, 2016 that would significantly overhaul benchmark calculations for Medicare Shared Savings Program Accountable Care Organizations (MSSP ACOs), which may increase the long-term attractiveness of the MSSP for high-performing ACOs.… Continue reading

Physician-assisted dying: Where are we now and where are we going?

By on January 21, 2016 Posted in General

What is the current status of physician-assisted dying in Canada? For most of Canada’s history, physician-assisted dying was a crime: sections 14 and 241(b) of the Criminal Code absolutely prohibited any person from assisting another person to commit suicide and provided that any person who violated this prohibition was liable to imprisonment for up to 14 … Continue reading