News & Analysis as of

Reimbursements Enforcement

King & Spalding

OIG Report Details Weaknesses in Enforcement of Two-Midnight Rule

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CMS estimates that between 2017 and 2021, Medicare Part A improperly paid $23.9 billion for inpatient hospital stays, with $7.8 billion attributable to short stays that did not qualify for Medicare Part A. On June 13, 2024,...more

Snell & Wilmer

The Ninth Circuit Finds Tribal Nation Waived Sovereign Immunity Through Arbitration Provision

Snell & Wilmer on

On June 10, 2024, the Ninth Circuit entered an opinion finding that the Choctaw Nation had expressly waived its sovereign immunity against arbitration, determining that the contractual provision between the Nation and...more

Hinshaw & Culbertson - Health Care

California Prohibits PBM Discriminatory Practices Against 340B Program Covered Entities and Contract Pharmacies

The 340B Drug Program requires pharmaceutical manufacturers participating in the Medicaid program to provide covered outpatient drugs at significantly reduced prices to certain health care organizations and programs, referred...more

Proskauer - Law and the Workplace

New York City Adopts Final Rule Regarding Amendments to the Earned Safe and Sick Time Act

On September 15, 2023, the New York City Department of Consumer and Worker Protection (“DCWP”) published a Final Rule adopting amendments to portions of the city’s Earned Safe and Sick Time Act (“ESSTA”). Employers will have...more

Keating Muething & Klekamp PLL

Benefits Monthly Minute - August 2023

The August Monthly Minute presents Part II of our mental health parity update and provides highlights of the latest report to Congress on NQTL comparative analyses. While service providers lead the way through mental health...more

Robinson+Cole Health Law Diagnosis

Connecticut Expands Applicability of State False Claims Act

On June 26, 2023, Connecticut Governor Ned Lamont signed into law Public Act 23-129: “An Act Concerning Liability for False and Fraudulent Claims” (the Act). The Act expands application of Connecticut’s False Claims Act...more

Benesch

Opportunities and Challenges for Office-Based Labs and Ambulatory Surgery Centers: Six Main Takeaways from the Benesch Healthcare+...

Benesch on

Six Main Takeaways from the Benesch Healthcare+ Nephrology & Dialysis Conference. Experts included Dapo Afolabi, M.D., President and CEO of Fort Worth Renal Group, Terry Litchfield, President of Access Solutions, Jason...more

Kohn, Kohn & Colapinto LLP

The Government’s Ability to Combat Fraud is on the Line in False Claims Act Supreme Court Case

Oral arguments are scheduled for April 18, 2023, in the Supreme Court case combining two Seventh Circuit Court of Appeals cases U.S. ex rel. Schutte v. SuperValu, Inc. (“SuperValu”) and U.S. ex rel. Thomas Proctor v. Safeway,...more

Baker Donelson

Sixth Circuit Joins Eighth Circuit and Widens Circuit Split by Requiring "But-For" Causation in Some Anti-Kickback Cases

Baker Donelson on

In a much-welcomed step by the defense bar, on March 28, 2023, the United States Court of Appeals for the Sixth Circuit became the second federal appellate court to hold that "resulting from" under the 2010 amendment to the...more

Foley & Lardner LLP

Growing Scrutiny of Private Equity in Health Care

Foley & Lardner LLP on

The presence of private equity (PE) investment has exploded in recent years in all areas of the health care sector. PE in health care is a good thing when done right: It can pave the way for much needed innovation,...more

Foley & Lardner LLP

Warranty and Pricing Disputes Between Suppliers and OEMs: Trends, Pitfalls and Preparation

Foley & Lardner LLP on

Over the course of the last three years, original equipment manufacturers (OEMs) and suppliers have been rocked by a series of challenges, including shutdowns and restarts due to COVID-19, extreme labor turnover, higher...more

ArentFox Schiff

Investigations Newsletter: DOJ Indicts 47 Individuals in Largest COVID-19 Fraud Scheme To Date

ArentFox Schiff on

DOJ Indicts 47 Individuals in Largest COVID-19 Fraud Scheme To Date - On September 20, 2022, the US Department of Justice (“DOJ”) announced federal criminal charges against 47 defendants from the nonprofit, Feeding Our...more

Fox Rothschild LLP

Surprise: Long Term Care Providers Are Not Exempt from The No Surprises Act’s Good Faith Estimate Requirement for Uninsured and...

Fox Rothschild LLP on

The federal No Surprises Act and interim final rules implementing the Act went into effect on January 1, 2022. Part I is aimed at reducing “surprise bills” to patients in the context of services provided at hospitals and...more

McDermott Will & Emery

[Webinar] Healthcare Anti-Discrimination Litigation: What Payors Need to Know - May 13th, 1:00 pm - 2:00 pm ET

McDermott Will & Emery on

As we continue our three-part webinar series, McDermott’s litigation and healthcare lawyers will focus on how payors can actively prepare for possible enforcement and litigation stemming from recent and potential changes to...more

K&L Gates LLP

Veteran Affairs Auditing US$35 Billion in Payments to Community Care Providers

K&L Gates LLP on

The Department of Veteran Affairs (VA) has long outsourced care for veterans that the VA could not provide and for veterans’ emergency care (community care). Over the past decade, the VA has experienced significant...more

Blank Rome LLP

Friday Afternoon Smackdown – The SEC v. The House Of Representatives

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On Friday, June 20, 2014, the Securities and Exchange Commission filed an action against the Committee on Ways and Means of the U.S. House of Representatives and congressional staffer Brian Sutter seeking enforcement of...more

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