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Due Process Health Care Providers

Jones Day

Eighth Circuit Holds Penalties in Non-Intervened FCA Case Violate Excessive Fines Clause

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The Situation: The False Claims Act ("FCA") imposes treble damages on defendants, as well as mandatory penalties per false claim. Because alleged false claims often involve much smaller amounts—for example, in cases with a...more

K&L Gates LLP

What's Been Missing: District Court Orders the Government to Produce Complete Universe of Claims in Provider's Due Process...

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On 5 March 2024, in an issue of first impression in the District of South Carolina, a district court judge overseeing judicial review of a final agency decision in a Medicare claims appeal ordered the Government to complete...more

Epstein Becker & Green

Telehealth’s Roadblock: The Issue with State Licensure Requirements

Use of telehealth services has surged since the COVID-19 pandemic; however, this increase in use does not come without limitations. Telehealth providers are subject to regulations, which differ by state, that govern various...more

Epstein Becker & Green

SCOTUS Lets National Practitioner Data Bank Safeguards Stand

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Last month, the U.S. Supreme Court declined to review a case challenging the sufficiency of due process protections in the Health Care Quality Improvement Act (HCQIA) and National Practitioner Data Bank (NPDB), effectively...more

Dorsey & Whitney LLP

What risks do employers face by excluding coverage for gender affirming care in their health plans?

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In recent years, courts have ruled upon a growing number of cases arising from delivery of and payment for gender affirming care. At the same time, state legislatures have passed a variety of laws aimed at such services. ...more

Morrison & Foerster LLP - Left Coast Appeals

This Week at The Ninth: No Fly and State Rules

This week, the Ninth Circuit again revives a plaintiff’s challenge to the government’s (since revoked) decision to place him on the No Fly List, and it wrestles with the application of Washington State’s procedural...more

ArentFox Schiff

Court Enjoins Federal Government from Enforcing Key Provisions of Executive Order 13950

ArentFox Schiff on

In a major setback for the Trump administration, US District Court Judge Beth Labson Freeman, of the US District Court for the Northern District of California, issued a nationwide injunction, barring the federal government...more

Polsinelli

Med-Staff Newsletter - January 2020 | VOL 4

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With the New Year comes new medical staff leaders and a new set of growing pains. Contrary to what many of us believe, some simple steps can lessen the pain. ...more

Nossaman LLP

Is It the End of Yaqub for Hearing Officer Selection?

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For more than 15 years, the process of selecting a hearing officer for a medical staff peer review proceeding has been strongly influenced by the decision in Yaqub v. Salinas Valley Memorial Healthcare System 122 Cal. App....more

Patrick Malone & Associates P.C. | DC Injury...

Virginia hospital assailed for seeking court actions to strip patients of decisions on care

A Virginia hospital has found an eyebrow-raising solution to some of  its struggles with elderly, poor, and sick patients who take up beds and medical resources that might generate more revenue and less headache for the...more

Arnall Golden Gregory LLP

Tracking the Docket for Challenges to Medicare Post-Payment Review

With the introduction of RACs, ZPICs, and UPICs, the administrative process for Medicare payment disputes has resulted in three to five year delays in adjudicating claims while providers are faced with almost certain...more

Fisher Phillips

3.8 Million Reasons Why Proper Process in Physician Discipline Matters

Fisher Phillips on

Any avid watcher of medical dramas would tell you that a hospital always has the ability to cut ties with any doctor who is not up to snuff. (For podcast fans we highly recommend Dr. Death.) They would tell you this is...more

Nelson Mullins Riley & Scarborough LLP

Fifth Circuit Reverses Dismissal of Complaint Seeking Injunction to Prevent Medicare Recoupment Prior to Conclusion of...

On March 27, 2018, the Fifth Circuit Court of Appeals in Family Rehabilitation, Inc. v. Alex Azar, II, Sec. U.S. Dept. of Health & Human Services, No. 17-11337, 2018 WL 1478052, at *1 (5th Cir. Mar. 27, 2018), reversed the...more

Arnall Golden Gregory LLP

Momentum is Building: Another Federal Court Stops Recoupment During a ZPIC Appeal, Citing Backlog in Medicare Appeals Process as...

Medicare’s implementation of post-payment review through overly aggressive zone program integrity contractors (ZPICs) and unified program integrity contracts (UPICs), combined with an ineffective review process at the first...more

Foley & Lardner LLP

CMS Recoupment Efforts Stopped by Court While Overpayment Appeals Are Pending

Foley & Lardner LLP on

Providers and suppliers who have been assessed overpayments for Medicare services are entitled, by statute, to a stay of recoupment while the provider or supplier’s appeal is pending – but only at the first two levels of...more

Jones Day

Texas Federal District Court Prevents Withholding of Medicare Payments

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In a much-anticipated decision in Family Rehab., Inc. v. Azar, Federal Judge Kinkeade enjoined the Centers for Medicare & Medicaid Services ("CMS") from withholding Medicare payments to effectuate the recoupment of the...more

Jones Day

Fifth Circuit Provides Relief for Providers Facing Medicare Appeal Backlogs

Jones Day on

The U.S. Court of Appeals for the Fifth Circuit has provided some relief to health care providers seeking to stop Medicare from "recouping" alleged overpayments before the provider can obtain a hearing before an...more

Baker Donelson

Court Finds Jurisdiction to Bar Recoupment Associated with Pending Claims Appeal

Baker Donelson on

On March 27, 2018, the United States Court of Appeals for the Fifth Circuit published an opinion that provides Family Rehabilitation, Inc. (Family Rehab) a second chance to postpone recoupment of about $7.6 million in...more

Arnall Golden Gregory LLP

Georgia’s Certificate of Need Law Lives to See Another Day

Despite an attack that went up to the Georgia Supreme Court, it appears that the State’s Certificate of Need (CON) law will live to see another day. On October 16, 2017, the Georgia Supreme Court issued an opinion written by...more

Cohen & Gresser LLP

How an Uncommonly Silly Law Led to a Host of Very Consequential Supreme Court Decisions

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In 1879, Connecticut passed a law barring the use of “any drug, medicinal article or instrument for the purpose of preventing conception”; the penalty was“not less than fifty dollars” or between 60 days and one year in...more

Maynard Nexsen

South Carolina Court Decides Key Health Care Case - Physical therapists win in employment lawsuit

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The South Carolina Supreme Court has decided a case with great significance in the health care industry. The court overturned a ban on physicians employing physical therapists and gave guidance regarding how state agencies...more

Williams Mullen

New Mexico Senator Proposes Forefront State Legislation to Provide Due Process to Providers Accused of Fraud (Oh, And Here Are...

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Whew…the election is over. No more political ads, emails, and other propaganda… Ok, so we have our new elected officials, now our new elected officials need to pass some new legislation protecting providers when it comes to...more

Nossaman LLP

Lessons On Peer Review For Calif. Hospitals And Physicians

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On June 6, 2013, the California Supreme Court ruled unanimously in El-Attar v. Hollywood Presbyterian Medical Center that the delegation of a peer-review matter to the hospital's governing board did not violate a physician's...more

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