Comparison of Presidential Candidates’ Health Care Proposals
Health Care
September 22, 2008
Cynthia E. Berry
Leah Mendelsohn Stone
As part of their campaigns for the presidency, both Senator McCain and Senator Obama have outlined health care reform proposals that aim to provide access to affordable health care. The candidates’ plans differ on how they would achieve their stated objectives.
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New Stark Rules Bring Major Changes - 08/08
Health Care
August 27, 2008
Sandra K. Herron
On August 19, 2008, the Centers for Medicare and Medicaid Services published the latest changes to the Stark Law. The Stark Law regulates the types of arrangements into which physicians may enter. Violations of the Stark Law bring hefty civil fines and penalties.
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HHS Proposes New Authority for Secretary to Overturn or Remand Departmental Appeals Board Decisions
Health Care
January 14, 2008
On December 28, 2007, the U.S. Department of Health and Human Services ("HHS") issued a proposed rule that would grant the Secretary of HHS new authority to overturn or remand certain decisions of the Departmental Appeals Board.
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OIG Advisory Opinion Approves Physician On-Call Coverage Payment Arrangement - 10/24/07
Health Care
October 24, 2007
The Office of Inspector General issued an Advisory Opinion on September 27, 2007 announcing its approval of an arrangement in which a nonprofit hospital compensated physicians for emergency department on-call coverage.
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Stark II, Phase III: And Still More to Come! - 09/14/07
Health Care
September 14, 2007
Sandra K. Herron
On August 27, 2007, The Centers for Medicare and Medicaid Services
(CMS) released the third phase of rulemaking to amend the regulations
implementing the Ethics in Patient Referrals Act, commonly known as
"Stark." This Phase III Final Rule (Phase III) was published on
September 5, 2007 and will become effective 90 days later, on December 5, 2007. In publishing Phase III, CMS both responds to public comments on Phase II and addresses the entire regulatory scheme.
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Congress Passes New Ethics, Lobbying, and Earmark Requirements - 08/20/07
Health Care & Advocacy & Government Relations
August 20, 2007
Cynthia E. Berry
Before recessing for the month of August, the U.S. House of Representatives and the U.S. Senate passed the "Honest Leadership and Open Government Act" (S. 1), which would tighten ethics guidelines, restrict lawmakers' interactions with lobbyists, increase lobbying disclosure, and impose new requirements on earmarking of federal funds.
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Proposed Stark Amendment Targets Physician-Owned Hospitals - 08/08/07
Health Care
August 8, 2007
On July 23, 2007, Representative Pete Stark co-sponsored legislation that included a proposed amendment to the Ethics in Patient Self-Referral Statute (the "Stark law"). The proposed amendment is part of the Children's Health and Medicare Protection Act of 2007 and significantly limits an important existing exception to the Stark law prohibition on certain physician referrals to hospitals.
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CMS Document Sheds Light on the New Medicaid World - 07/31/07
Health Care
July 31, 2007
Sandra K. Herron
On July 20, 2007, the Centers for Medicare and Medicaid Services (CMS) Office of Acquisition & Grants Management issued a document that provides vital information to health care providers about what to expect during the coming years of intensified Medicaid review and enforcement.
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CMS Says Providers Can Charge for Missed Appointments - 07/18/07
Health Care
July 18, 2007
On June 29, 2007, the Center for Medicaid & Medicare Services ("CMS") implemented a new policy that will allow physicians, providers, and suppliers to charge Medicare beneficiaries for missed appointments.
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National Provider Identifier Deadline Eased - Slightly 04/16/07
Health Care
April 16, 2007
Sandra K. Herron
Implementation of a single, standardized provider identifier is a mammoth undertaking, and one that requires close attention to testing and planning. CMS estimates that once a Covered Entity obtains its NPI, the testing and implementation process will take 120 days - a time period longer than the time remaining before the May 23, 2007 deadline.
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CMS Posts List of Quality Measures for Physician Quality Reporting - 04/16/07
Health Care
April 16, 2007
Interested providers should review the list of quality measures to determine those measures that apply to their practices and begin preparing for submission of the quality data.
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Third Circuit Ruling: When Does the Fiduciary Exception to the Attorney-Client Privilege Not Apply? 04/09/07
Health Care
April 10, 2007
Paige Arden Stanley
Under the common-law evidentiary rule known as the "fiduciary exception" to the attorney-client privilege, certain fiduciaries who obtain legal advice during the execution of their fiduciary obligations may not thereafter assert the attorney-client privilege against their beneficiaries.
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Fiscal Year 2008 Senate Budget Resolution - 03/21/07
Health Care
March 21, 2007
Alan K. Parver
Leah Mendelsohn Stone
On March 15 the Senate Budget Committee reported its fiscal 2008 budget resolution. The budget resolution contains notable provisions relating to Medicare and the State Children's Health Insurance Program (SCHIP). It also includes funding for Federally Qualified Health Centers.
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Healthcare Businesses and the Appointment of a Patient Care Ombudsman in Bankruptcy - 03/14/07
Bankruptcy & Financial Restructuring
March 14, 2007
Wendy L. Hagenau
Under the Bankruptcy Abuse Prevention and Consumer Protection Act of 2005 ("BAPCPA"), a number of special provisions were enacted for "healthcare businesses". One provision in particular requires the appointment of a patient care ombudsman in a case under chapter 7 (liquidation) or chapter 11 (reorganization) if the debtor is a healthcare business.
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CMS Withdraws Heightened Restrictions for Independent Diagnostic Testing Facilities - 03/06/07
Health Care
March 6, 2007
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CMS Manual IDTF Changes - 02/13/07
Health Care
February 13, 2007
On January 26, 2007, the Centers for Medicare and Medicaid Services ("CMS") released modifications to the CMS Medicare Program Integrity Manual, Pub. 100-08 (the "Manual"), which detail CMS' position on carrier and contractor enforcement of new requirements for independent diagnostic testing facilities ("IDTF"s).
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MRI Lease Agreements: Problems at a State Level - 01/31/07
Health Care
January 31, 2007
Illinois Attorney General Joins Whistleblower Suit Challenging Sham Physician Lease Arrangement
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OIG Finds Medicare Beneficiaries Not Receiving Drug Subsidies - 11/27/06
Health Care
November 27, 2006
Cynthia E. Berry
On Friday, November 17, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) released a report highlighting that low-income Medicare beneficiaries are not receiving the drug subsidies to which they are entitled under the new Medicare drug benefit.
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Virginia Mason Settles Provider-Based Facility Fee Class Action Suit - 11/07/06
Health Care
November 7, 2006
In January 2005, two patients of Virginia Mason Medical Center filed suit against the healthcare provider seeking recovery of "facility charges" for treatment received at the hospital's downtown outpatient clinic, which is connected to the main hospital.
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Fall Elections May Bring Increased Oversight of the Medicare Program - 10/30/06
Health Care
October 30, 2006
Alan K. Parver
Representative Fortney "Pete" Stark, Ranking Minority Member for the House Ways and Means Health Subcommittee recently identified areas in health law and policy that could draw the attention of a Democratically-led Congress.
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Congress Fails to Reach Health IT Agreement - 10/10/06
Health Care
October 10, 2006
Lawmakers involved in negotiating the differences between two health information technology (Health IT) bills (H.R. 4157, S. 1418) failed to reach an agreement prior to Congress' recess. The bills may still go to a conference committee if lawmakers can reconcile the differences.
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JCAHO Revises Credentialing Process Requirements - 10/04/06
Health Care
October 4, 2006
The Joint Commission on Accreditation of Healthcare Organizations ("JCAHO") recently released the 2007 Pre-Publication Medical Staff Standards for Hospitals. Considerable changes have been made to the medical staff chapter. Some of the more significant differences are in the area of medical staff credentialing.
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OIG 2007 Work Plan: Risk Areas for Physicians and Physician Practices - 10/04/06
Health Care
October 4, 2006
On September 25, 2006, the United States Department of Health and Human Services' (HHS) Office of the Inspector General (OIG) published its Fiscal Year 2007 Work Plan. In general, the Work Plan identifies areas perceived by OIG as having a high risk for abuse in the programs and activities administered by HHS, and provides a list of areas in which providers can expect the OIG to pursue enforcement activities, and therefore, a road map for providers' compliance programs, monitoring, and follow-up.
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MedPAC Discusses the Future of Medicare DSH and IME - 09/18/06
Health Care
September 18, 2006
On September 7 and 8, the Medicare Payment Advisory Commission (MedPAC) met in Washington to discuss the future of Medicare Disproportionate Share Hospital (DSH), Indirect Medical Education payments, and improvements to Medicare physician payments
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Medicaid Commission Hears Testimony on Medicaid Financing Issues - 09/08/06
Health Care
September 8, 2006
On September 6 and 7, the Medicaid Commission met in Arlington, Virginia. One of the presentations focused on Medicaid reimbursement, financing issues, and the Bush Administration's budget proposals. The 28-member body, appointed by Department of Health and Human Services ("HHS") Secretary Michael Leavitt, was tasked in 2005 with advising HHS and Congress on ways to reform and modernize the Medicaid program. The Commission is comprised of current and former governors, state Medicaid officials, health policy academics, business leaders, patient advocates, and representatives from the provider community.
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Executive Order Requires Health Care Price and Quality Information for Consumers -08/29/06
Health Care
August 29, 2006
On August 22nd, President Bush signed an executive order that requires departments that administer federal health care programs to provide cost and quality information to beneficiaries so that they can compare providers and services.
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E-Regulation At Last - 08/29/06
Health Care
August 29, 2006
Sandra K. Herron
On August 8, 2006, the Office of Inspector General of HHS and Centers for Medicare and Medicaid Services published final rules creating a safe harbor to the Anti-kickback Statute and an exception to the Stark law for health information technology. Under the new rules, a hospital, or certain other entity "donors," may donate technology to physicians, or certain other "recipients," that facilitates the implementation of electronic health records and electronic prescribing.
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CMS' Proposed Changes To Medicare Physician Fee Schedule: Implications For Stark II, Reassignment Rules, & IDTFS - 08/22/06
Health Care
August 22, 2006
On June 29, 2006, the Centers for Medicare and Medicaid Services ("CMS") issued a notice in the Federal Register that included proposed revisions to the work relative value units (RVUs) and proposed changes in the methodology for calculating practice expense RVUs. Less than two months later, on August 8, 2006, CMS announced that its release of a proposed rule to "revise payment rates and policies under the Medicare Physician Fee Schedule" (the "Proposed Rule").
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CMS Releases Quality Standards for DMEPOS Suppliers - 08/22/06
Health Care
August 22, 2006
Alan K. Parver
On August 14, 2006, the Centers for Medicare and Medicaid Services (CMS) issued quality standards for suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS). Read details in our alert.
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CMS Issues Outpatient Prospective Payment Proposed Rule - 08/15/06
Health Care
August 15, 2006
Leah Mendelsohn Stone
On August 8, CMS issued the proposed rule for the outpatient prospective payment system for calendar year 2007. In the same rule, CMS proposed a revision of payments for ambulatory surgical centers.
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OIG Calls For Better Oversight of 340B Program - 7/25/06
Health Care
July 25, 2006
Congress established the 340B Drug Discount Program in 1992 to allow certain providers to receive substantial discounts on outpatient drugs because they serve the nation's poor and uninsured.
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OIG Study Results in Decrease in Physician Reimbursement for Five Oncology Procedure Codes - 07/18/06
Health Care
July 18, 2006
The Office of the Inspector General of the Department of Health and Human Services ("OIG") has released its report, "A Comparison of Average Sales Prices to Widely Available Market Prices: Fourth Quarter 2005," detailing the OIG's findings on the prices paid by hematologists and medical oncologists for thirty-nine Medicare Part B prescription drugs.
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CMS Proposes Payment Increases for Physician E&M Services - 07/07/06
Health Care
July 7, 2006
On June 21, 2006, the Center for Medicare & Medicaid Services (CMS) notified providers of its proposed revisions to the Medicare Physician Fee Schedule. CMS' proposed revisions provide for significant payment increases for "evaluation and management" services, which cover physician time and effort spent with patients evaluating their conditions and counseling them in health management.
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New IRS Independent Contractor Test - 06/08/06
Health Care
June 8, 2006
In January of this year the Internal Revenue Service modified and simplified its test to determine whether an individual is working as an employee or independent contractor for employment tax purposes. This test has also been adopted by the Office of Inspector General and the Centers for Medicare/Medicaid Services for purposes of their bona fide employment safe harbor and exception under the Anti-Kickback Statute and the Physician Self-Referral Law known as the Stark Law.
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Problems with Physician Recruitment Agreements: Hospital Avoids Medicare Exclusion - 06/01/06
Health Care
June 1, 2006
On May 17, 2006, Tenet Healthcare Corporation has agreed to divest itself of Alvarado Medical Center ("Alvarado") in San Diego, protecting Alvarado from a possible exclusion from participation in Medicare, Medicaid and all other Federal health care programs.
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IRS Launches New Compliance Audit Initiative Targeting Hospital Bond Issues - 05/16/06
Public Law & Finance
May 16, 2006
Robert C. Lewinson
Do you have outstanding tax-exempt bonds? The IRS recently announced that it was launching a new audit initiative, targeting qualified 501(c)(3) bond issues in general, and hospital bond issues in particular. Audits will focus primarily on post-closing compliance by bond issuers and conduit borrowers - especially focusing on private use, federal research agreements, management contracts and lease arrangements.
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PBMs Win Another Battle but the War is Not Over - 05/03/06
Health Care
May 3, 2006
In a positive decision for the pharmacy benefit management industry, the United States District Court for the District of New Jersey recently held that a pharmacy benefits manager ("PBM") is not a fiduciary under the Employee Retirement Income and Security Act of 1974. Recent litigation and legislative trends reveal an increasing tendency to seek to hold PBMs to higher fiduciary duty standards.
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Inspector General Issues First Open Letter - 05/03/06
Health Care
May 3, 2006
On April 24, 2006, the Inspector General of the Department of Health and Human Services issued guidance encouraging providers to voluntarily disclose violations of the physician self-referral law and the Anti-Kickback Statute. This guidance is Daniel Levinson's, the Inspector General, first Open Letter to Health Care Providers. This guidance relates his perspectives on compliance, the resolution of health care fraud cases, corporate integrity agreements, and the OIG's Provider Self Disclosure Protocol. This letter also introduces a new voluntary disclosure initiative that supplements prior guidance issued in 1998.
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Once Again, Hospital's Unilateral Amendment of Medical Staff Bylaws Prohibited - 05/02/06
Health Care
May 2, 2006
In the wake litigation filed by the Medical staff of the Community Memorial Hospital of San Buenaventura and its ensuing settlement, see http://www.ama-assn.org/ama/pub/category/8102.html, a Florida court has struck down Lawnwood Medical Center's ability to unilaterally amend its Medical Staff bylaws. The Lawnwood case differs from San Buenaventura in that involves a St. Lucie County, Florida hospital governance law.
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Significant Changes to Medicare Hospital Payments Announced - 05/02/06
Health Care
May 1, 2006
Several important policy changes affecting the Medicare program were announced this month including release of the proposed Medicare inpatient prospective payment system (IPPS) rule for FY 2007, which includes sweeping changes to Medicare payment methodology. In addition, its is likely that the Centers for Medicare and Medicaid Services will fully implement the Medicare occupational mix adjustment as well as lower payments to physicians. Read details in our Alert.
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OIG Clarifies that Pharmaceutical Companies May Continue Patient Assistance Programs under Medicare Part D - 04/25/2006
Health Care
April 25, 2006
Raquel M. Gayle
On April 18th, 2006, the Office of Inspector General, the agency tasked with enforcing the Anti-kickback Statute ("AKS"), issued a new Advisory Opinion confirming that a pharmaceutical company's patient assistant programs for low-income Medicare beneficiaries would not pose a substantial risk of fraud and abuse under AKS.
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State Legislators & Physicians Scrutinize The Pharmaceutical Industry's Gift-Giving Marketing Tactics - 04/12/06
Healthcare
April 12, 2006
Legislators in several states contemplate stricter regulation of the prescription drug industry's $7.3 billion annual physician marketing campaign with some physician support.
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Proposed Rules Expand National Practitioner Data Bank - 04/04/06
Health Care
April 4, 2006
On March 21, 2006 the Department of Health and Human Services ("HHS") released Proposed Rules for the National Physician Data Bank that would incorporate statutory requirements under Section 1921 of the Social Security Act ("Section 1921"). Section 1921 requires states to report to HHS certain adverse licensure actions taken against health care entities as well as health care practitioners.
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Finally, Nurse Practitioners Authorized to Write Prescriptions - 04/04/06
Health Care
April 4, 2006
On March 27, 2006, legislation that will allow nurse practitioners to write prescriptions for patients left the Georgia State legislature for the Governor's signature. The bill and others like it were stalled in various committees, but lobbyists were successful in tacking on the necessary language to another unrelated nursing measure, Senate Bill 480, as an amendment.
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11th Circuit Dismisses Class Action Lawsuit Attacking Billing Practices Of Not-For-Profit Hospital Group - 03/21/06
Health Care
March 21, 2006
Eric P. Schroeder
In the first ruling by a federal court of appeals on the validity of claims brought by uninsured patients attacking the billing practices of not-for-profit hospitals, the Eleventh Circuit Court of Appeals dismissed the proposed class action complaint of several uninsured patients on res judicata and statute of limitations grounds. Kizzire et al. v. Baptist Health System, Inc., Co., 04-16017 (March 9, 2006). The case was on appeal from the U.S. District Court for the Northern District of Alabama.
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Finally: Proposed Rules For E-Prescribing and EHR - 11/15/05
Health Care
November 15, 2005
This second part of a three-part series on E-Prescribing and Electronic Health Records ("EHR") will address the potential issues that may arise for physicians and physician group practices due to the implementation of the e-prescribing and EHR proposed rules ("Proposed Rules") released by the Health and Human Services' Office of the Inspector General and the Centers for Medicare and Medicaid Services.
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Electronic Medical Records on the Fast Track - 10/10/05
October 10, 2005
This Health Care Update discusses a new series of Health and Human Services regulations that will accelerate the use and the implementation of electronic medical records ("EMR") and electronic prescribing.
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Hurricane Response: Government Suspends Certain Healthcare Laws - 9/12/05
Health Care Client Alert
September 12, 2005
Sandra K. Herron
In the wake of what many are calling the greatest disaster in United States history, both the Federal and the Louisiana State governments have suspended the application of certain healthcare laws to the extent necessary, in the words of the Secretary of Health and Human Services, "to ensure that sufficient health care items and services are available to meet the needs of individuals enrolled in Medicare, Medicaid and SCHIP programs, and to ensure that health care providers that furnish such items and services in good faith, but are unable to comply with one or more of these requirements as a result of the effects of Hurricane Katrina, may be reimbursed for such items and services and exempted from sanctions for such noncompliance, absent any determination."
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CMS Issues First Stark Advisory Opinion Since 1998 - 08/29/05
Health Care
August 29, 2005
The Centers for Medicare and Medicaid Services has issued its first advisory opinion under the Stark law, 42 U.S.C. § 1395nn et seq., since November, 1998.
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Recent Study Finds That State Certificate Of Need Laws Are The Optimal Way To Regulate Physician-Owned Specialty Hospitals And Guarantee Ongoing Financial Viability Of Community Hospitals - 08/22/05
Health Care
August 22, 2005
A recent study ("Specialty Versus Community Hospitals: What Role For The Law?") published online by the journal Health Affairs states that the country's market-driven health care system is endangering the financial viability of our general community hospitals.
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Government Scrutiny of Arrangements Between Physicians - 08/08/05
Health Care
August 8, 2005
Turn-key arrangements, where the imaging center "leases" all equipment, personnel and supplies necessary to provide imaging services to a referring physician's patients at the center's facility, are of particular interest to the government.
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Sale of Non-Profit Hospitals in Bankruptcy - 06/30/05
Health Care
June 30, 2005
Wendy L. Hagenau
It is not uncommon in a bankruptcy case for the debtor to sell its assets, either as part of a plan of reorganization or liquidation or pursuant to section 363 of the Bankruptcy Code. The Bankruptcy Code provides that such a sale occurs after notice to all creditors and an opportunity for a hearing.
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HIPAA Portability Final Regulations - 05/16/05
Employee Benefits & Executive Compensation
May 16, 2005
Richard L. Arenburg
Armin G. Brecher
Paul F. Concannon
Edmund Emerson III
Castles R. Hollis
Steven G. Schaffer
The federal agencies enforcing HIPAA's "portability" requirements have issues final regulations that will become effective for plan years beginning on or after July 1, 2005.
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New Stark Rules Bring Major Changes - 08/26/08
Health Care
Sandra K. Herron
Sandra K. Herron
On August 19, 2008, the Centers for Medicare and Medicaid Services published the latest changes to the Stark Law. The Stark Law regulates the types of arrangements into which physicians may enter. Violations of the Stark Law bring hefty civil fines and penalties.
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