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Employer Wellness Programs Operating Under a Cloud of Uncertainty

Wellness programs have quickly found favor with many employers: studies indicate that nearly half of employers who sponsor a health plan offer a wellness program. However, wellness programs have been operating under cloud ever since a federal court decision invalidated guidance issued by the EEOC that an incentive to participants equal to 30% of the cost of coverage under the group health plan was permissible. In December 2018, the EEOC revoked its guidance and the agency is expected to offer new guidance later in 2019. More ›

Health Care Organizations Should Take Heed of New HHS Cybersecurity Guidance

Cybersecurity is a significant and growing compliance risk for health care organizations. If your organization fails to protect patients from cybersecurity risks, the result could be serious fines and penalties for non-compliance with federal and state cybersecurity and data breach laws. The good news is that the U.S. Department of Health & Human Services ("HHS") recently released voluntary cybersecurity guidance for health care organizations. More ›

OIG Issues Advisory Opinion Allowing a Federally Qualified Health Center to Routinely Waive Co-Payments and/or Deductibles for Medicare and TRICARE Patients

On January 14, 2019, the U.S. Department of Health and Human Services Office of the Inspector General (the "OIG") issued Advisory Opinion 19-01, which was favorable to a federally qualified health center's ("FQHC's") proposal to routinely waive co-payments and/or deductibles for Medicare and TRICARE patients (the "Proposed Arrangement"). The particular FQHC that made the request is a pediatric clinic that provides medical, psychiatric, and dental care to children who reside in an area that contains disproportionately large numbers of children living in poverty. More ›

What Health Care Providers Need to Know About the Illinois Gender Violence Act

Years before the rise of the "#MeToo" movement, the Illinois Gender Violence Act (IGVA) was enacted to give victims of criminal "gender violence" a civil remedy. The IGVA creates a civil cause of action for persons who have been subjected to gender-related violence, which is defined in part as, "a physical intrusion or physical invasion of a sexual nature under coercive conditions satisfying the elements of battery under the laws of Illinois." A cause of action under the IGVA exists regardless of whether the alleged act of sexual aggression resulted in criminal charges, prosecution, or conviction. Essentially, any claim involving sexual harassment and physical touching could arguably fall within the scope of the statute. More ›

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 ›

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