As promised, our team has been studying the two final rules published by the Department of Health & Human Services (HHS) (one by the Office of Inspector General (OIG) and one by the Centers for Medicare & Medicaid Services...more
12/7/2020
/ Anti-Kickback Statute ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
DMEPOS ,
Final Rules ,
Health Care Providers ,
OIG ,
Remuneration ,
Safe Harbors ,
Stark Law ,
Value-Based Care
Last week, the New York State Department of Financial Services released a proposed amendment to the regulations promulgated under the state’s Emergency Medical Services and Surprise Bills law (the SBL), which adds additional...more
10/14/2019
/ Amended Regulation ,
Consumer Protection Laws ,
Health Care Providers ,
Health Insurance ,
Medical Expenses ,
New Legislation ,
NYDFS ,
Out of Network Provider ,
Prior Express Consent ,
Proposed Regulation ,
State and Local Government ,
Surprise Medical Bills
On January 15, 2019, Governor Cuomo released the 2019-2020 Executive Budget, which proposes substantial legislative changes that would affect pharmacy benefit managers (PBMs). Among other things, the law would require PBMs to...more
News alert for all New Jersey health care providers! A new law went into effect yesterday (August 30, 2018) that changes billing requirements for out-of-network services in New Jersey. Known as the “Out-of-Network Consumer...more
Last week, Governor Andrew Cuomo unveiled his proposed $168 billion budget for fiscal year 2019, which proposes several changes to New York’s healthcare landscape. Among other things, the budget contains amendments that would...more
The Department of Health and Human Services Office of the Inspector General (OIG) has issued an Advisory Opinion (Opinion) in connection with a hospital’s gainsharing arrangement (Arrangement) with a designated group of...more
1/11/2018
/ Anti-Kickback Statute ,
Cherry Picking ,
Civil Monetary Penalty ,
Compensation ,
Department of Health and Human Services (HHS) ,
Health Care Providers ,
Medicaid ,
Medical Reimbursement ,
Medicare ,
OIG ,
Physicians ,
Stark Law
A series of recoupment letters from the New York State Medicaid Fraud Control Unit (MFCU) to healthcare providers who have management or billing company arrangements based on a percentage of collections has prompted the...more
Last month the California legislature passed AB-72, which amends the Health & Safety Code to address reimbursement for out of network (OON) providers who provide services at in-network facilities, such as hospitals and...more
It is generally understood that if a managed care member utilizes the services of a non-participating provider, the member could incur significant out of pocket expenses. However, there are instances where a member may...more
Just as the Centers for Medicare & Medicaid Services (CMS) began holding federal health care plans accountable for their provider network transparency obligations, the New Jersey legislature stalled in its bid to pass a law...more
A Federal Judge found that the Department of Health and Human Services (DHHS) failed to comply with the Administrative Procedure Act (APA) when it cut hospital inpatient payments by 0.2% as part of its “two-midnight” rule. ...more
One of the most frequently asked questions posed to healthcare lawyers is whether State X has a prohibition on the corporate practice of medicine, nursing or other profession, and if so, whether the prohibition is enforced. ...more
7/31/2015
/ Anti-Kickback Statute ,
Attorney General ,
Billing ,
Civil Monetary Penalty ,
Corporate Management ,
Corporate Practice of Medicine ,
Dentists ,
Government Investigations ,
Management Agreements ,
Nurses ,
Physician Compensation Arrangements ,
Physicians ,
Quality of Care Standards ,
Settlement
In an April 22, 2015 letter to the New York State Department of Health (DOH), the Federal Trade Commission (FTC) cautioned that part of the State’s Medicaid reform program may sanction anticompetitive behavior. The FTC’s...more
Last week, new bi-partisan legislation was introduced to increase the number of graduate medical education (GME) slots over the next five years at teaching hospitals and academic medical centers. If passed, the Resident...more
Last year New York passed legislation known as the “Emergency Medical Services and Surprise Bills” law, a much-heralded consumer protection law primarily intended to guard against surprise bills for out of network (OON)...more
New York’s Emergency Medical Services and Surprise Bills law went into effect yesterday, which means consumers who receive out of network (OON) emergency services will no longer have to pay more than their usual in-network...more
New York became the 22nd state to sign into law legislation that will require commercial and Medicaid plans to provide coverage of telehealth and telemedicine services. The law, originally intended to take effect on January...more
On November 24, 2014, the New Jersey Appellate Division affirmed a lower court’s decision to dismiss a physician’s lawsuit against a hospital based on federal and state statutory immunity provisions that shield hospitals and...more
On October 15, 2014, the New York State Department of Health (DOH) released proposed changes that will simplify the certificate of need (CON) process. Specifically, the Department is proposing to require prior notice,...more
Last month, a woman sued a health plan, claiming that she was intentionally misled about which physicians were participating providers in the company’s online health insurance exchange established under the Affordable Care...more
The Accreditation Council for Graduate Medical Education (ACGME), American Osteopathic Association (AOA), and the American Association of Colleges of Osteopathic Medicine (AACOM) will be forming a unified, single...more
Recently, a colleague and I spoke at the NAMSS 37th Educational Conference & Exhibition to nearly 200 medical directors, chief medical officers, and credentialing staff about what constitutes disruptive physician conduct in...more
On October 16, 2013, a New York federal district court granted a partial motion to dismiss a Fair Labor Standards Act (FLSA) class action suit against the New York City Health & Hospitals Corp. (HHC), finding that HHC is a...more
In the early morning of October 1, 2013, the U.S. federal government officially went dark. The shutdown came in the aftermath of the Senate’s decisive vote to reject a House plan that would have kept the government funded for...more
The New York State Attorney General (AG) has teamed up with lawmakers to introduce two new bills that propose an overhaul of the Not-for-Profit Corporation Law (N-PCL), which has not seen significant change in more than 40...more