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Federal Legislation Addresses National Opioid Crisis, Will Impact the Entire Healthcare Industry

The U.S. healthcare industry needs to be aware of recent federal legislation that was signed into law on October 24, 2018. The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment, or SUPPORT for Patients and Communities Act, H.R.6, was signed into law as a response to the national opioid crisis. The law broadly addresses the opioid crisis in ways that will affect the entire health care industry. The law is immediately effective, except for certain individual provisions which specifically define when they will go into effect. More ›

CMS Requires Hospitals to Publish Standard Charges on the Internet

Section 2718(e) of the Public Health Service Act, which was enacted as part of the Affordable Care Act, updated Medicare payment policies to require that "each hospital operating within the United States, for each year, establish (and update) and make public (in accordance with guidelines developed by the Secretary) a list of the hospital's standard charges for items and services provided by the hospital." CMS provided guidance for implementation and stated hospitals are required to make the list of their standard charges, or their policies for public access to the list, available upon inquiry. More ›

How a Recent Interpretation of the Wisconsin "Borrowing Statute" Will Affect Multi-State Healthcare Practices in Wisconsin

Wisconsin businesses, including physician groups, clinics, and hospitals, operating across state lines facing personal injury exposure should be aware of a recent Wisconsin Court of Appeals opinion defining a clear test to evaluate whether a claim is untimely: Paynter v. ProAssurance Ins. Co., No. 2017AP739 (Mar. 27, 2018). The newly defined test specifically affects medical malpractice claims alleging a misdiagnosis and others where the claimed injury becomes apparent only after the alleged negligent conduct. Even if the subject conduct occurred in Wisconsin, a Wisconsin court can "borrow" the statute of limitations from another state if such an injury occurs outside the State in certain instances. In this case, the court declared Wisconsin "borrows" another State's statute of limitations when the first instance of "greater harm," greater than that which existed at the time of the subject conduct, occurs outside of Wisconsin. More ›

Midlevel Health Care Providers in Illinois and the Physicians They Collaborate With Should Take Note of Recent Legislation Impacting Their Practice

Illinois Senate Bill 2904—signed into law as Public Act 100-605 in July 2018 and going into effect on January 1, 2019—will increase the number of physician assistants (PAs) with which a physician may collaborate from five to seven. It also creates an exception for services provided in a federal primary care health professional shortage area (HPSA)—in those areas with a HPSA score of 12 or greater, there is no statutory maximum on the number of PAs with which a physician may collaborate. The new legislation will also grant the Department the authority to discipline both physicians and physician assistants (under the relevant practice Acts) for (1) entering into an excessive number of written collaborative agreements resulting in an inability to adequately collaborate, and (2) the repeated failure to adequately collaborate with the collaborating provider. These changes are effective January 1. More ›

Sixth Circuit Applies Escobar Ruling in Decision to Resuscitate False Claims Act Case

The United States Court of Appeals for the Sixth Circuit recently resuscitated a qui tam action under the False Claims Act (FCA), and, in so doing, held that the relator had properly alleged materiality under the U.S. Supreme Court's decision in Universal Health Services Inc. v. United States ex rel. Escobar, 136 S. Ct. 1989, 2002 (2016). The Sixth Circuit's decision, U.S. ex rel. Prather v. Brookdale Senior Living Communities, Inc., 892 F.3d 22 (6th Cir. June 11, 2018) addressed a relator's claims under the FCA. The FCA imposes civil liability on those who defraud the federal government by levying fines and penalties, including up to three times the government's damages. Private persons called relators file lawsuits or qui tam actions for violations of the FCA on behalf of the government. More ›

More than 600 Healthcare Professionals Hit by DOJ with Medicare Fraud Charges

The number of criminal charges filed annually by the Department of Justice (DOJ) against health care providers and professionals continues to escalate. On June 28, 2018, the DOJ announced that the Medicare Fraud Strike Force had charged 601 individuals across the United States, including more than 150 physicians, nurses, and other licensed medical professionals for participating in health care fraud schemes involving more than $2 billion in false billings this summer. At the same time, the U.S. Department of Health and Human Services initiated suspension actions against numerous providers, including doctors, nurses, and pharmacists. More ›

What Medical Providers and Hospitals should know before Prescribing Opioids in Illinois

We are in the middle of the deadliest drug crisis in U.S. history: the opioid epidemic. Federal, state, and local governments are scrambling to come up with a solution, along with health care providers, public interest groups, and the families of those affected. The statistics are shocking. According to a recent report from the Center for Disease Control and Prevention, overdoses from opioids increased by a staggering 29.7 % last year alone. The Illinois Department of Public Health reported that opioid overdoses have killed nearly 11,000 people since 2008 in Illinois, with 2,000 deaths occurring in 2017. How does this happen, and what are the solutions? It's an epidemic-sized question to tackle. More ›

NLRB Evaluation of Personnel Handbook Finds Moonlighting Policy Unlawful

Health care employers should take note of a recent decision of an Administrative Law Judge (ALJ) of the National Labor Relations Board (NLRB) which struck down a number of employer policies in a Personnel Handbook, including a limitation on anti-moonlighting. Anti-moonlighting provisions are common in health care provider contracts and in personnel manuals of health care providers, including group practices, hospitals and other larger health care employers. The reasons for such rules in the health care setting are straightforward and largely non-controversial. They include the fact that risk to patients go up if employees are fatigued at work. Health care providers also may require varying shifts or mandatory overtime. Such rules minimize workplace conflict when employees are unable to satisfy the staffing requirements of their primary employer because of a second job commitment. Obviously, working for a competitor provider is also something that most group practices, hospitals and other providers, seek to limit. More ›

What Medical Providers should know about "Custom and Habit" Testimony

"If it wasn't charted, it didn't happen." Most medical providers have heard the adage, but is it true? Due to the realities of practicing medicine, health care providers are occasionally unable to document each and every aspect of their care within the medical record. What's more, a medical provider's recollection of a given patient's care can fade by the time a lawsuit is filed. So how might a nurse, mid-level, or doctor handle an aggressive Plaintiff's attorney who questions how, in the absence of documentation and recollection, a provider can nevertheless testify that a certain type of care was provided? Some providers can rely on their "custom and habit" to explain how they treat similar patients under a specific set of circumstances. In other situations, like Szekeres v. Mary T. Riggs, however, "custom and habit" testimony can be inadmissible. More ›

Using Electronic Medical Records to Combat the U.S. Opioid Crisis

In 2017, President Donald Trump declared the opioid crisis a national public health emergency. According to the most recent data gathered by the Centers for Disease Control and Prevention (CDC), more than 40% of all U.S. opioid deaths in 2016 involved a prescription opioid, with more than 46 people dying every day from overdoses involving prescription opioids. While stakeholders across the healthcare continuum are fighting the opioid crisis on many fronts, optimizing electronic medical records (EMR) technology has become a significant legislative and regulatory priority in this battle.  More ›

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