Health Newsletters

Payment Matters
May 17, 2012

• CMS Proposes Changes to GME/IME Payment Rules and Provides Guidelines for § 5506 Application Process
• Reactivation of Billing Privileges - More Onerous for HHAs

Health Law Alert
2012: Issue 7

• Why EMTALA is Worth Another Look: Enforcement on the Rise
• Walgreens Settles Gift Card False Claims Act Allegations
• Massive Criminal Takedown Is Latest Salvo in Government's Intensified Campaign Against Health Care Fraud and Abuse

Payment Matters
May 3, 2012

• CMS Releases Proposed FFY 2013 IPPS Rule
• Protect Wage Index Budget Neutrality Issue by Protesting Amount on FYE 12/31/11 Cost Report
• CMS's Non-Hospital Training Rules Again Upheld
• Contracting Opportunities Begin for Dual Eligible Integrated Care

Health Law Alert
2012: Issue 6 - Focus on HIPAA/Privacy

• It's Coming: The HIPAA/HITECH Rule; What To Expect and What To Do Now
• Relief for Eligible Professionals? Proposed Stage 2 Meaningful Use Rule Includes Important (Potential) Exceptions
• OCR Settles with Small Physician Practice for HIPAA Violations

Payment Matters
April 19, 2012

• Court Upholds "Must-Bill" Policy for Dual-Eligible Bad Debts, Remands on Prior Lack of Enforcement
• CMS Reminds Providers of How Reasonable Cost Principles Apply to Provider Taxes

Health Law Alert
2012: Issue 5

• Website Coupons and Advertising from Health Care Providers Approved by OIG
• CMS Extends Community Based Transition Program

Payment Matters
April 3, 2012

• CMS Issues Revised 2006-2009 SSI Percentages

Health Law Alert
2012: Issue 4 - Focus on Long Term Care

• Health Care Reform: Independent Informal Dispute Resolution Coming to a State Survey Agency Near You
• New CMS Grant Focuses on Nursing Facility Residents to Solve Hospital Readmission Issue
• CMS Prevention and Wellness Services Beneficial in Long Term Care Setting
• OIG Okays Purchasing Structure Outside of Strict Compliance with Discount and GPO Safe Harbors
• HITECH Breach Enforcement Announced: BCBS Settles with OCR for $1.5 Million

Payment Matters
March 21, 2012

• Pre-Payment Review: CMS Contractors Fail to Follow the Rules
• CMS Announces New Hospital Value-Based Purchasing FAQs

Health Law Alert
2012: Issue 3

• Understanding the Use of Misdemeanors in Healthcare Enforcement

Payment Matters
March 8, 2012

• Job Creation Act Includes Key Medicare Payment Provisions

Health Law Alert
2012: Issue 2 – Focus on Fraud and Abuse

• Providers Beware: OIG Alert Highlights FCA Liability Under Contractual Reassignment
• CMS Publishes Self-Referral Disclosure Protocol Settlements
• Blowing the Whistle on Whistleblowers
• "Worthless Services" May Create Liability Under False Claims Act
• Supreme Court Endorses Nursing Home’s Use of Pre-Dispute Arbitration Agreement

Court Rules Dual Eligible Days Properly Included in Medicaid Fraction of Medicare DSH Calculation
February 16, 2012
By: Mark A. Stanley

Payment Matters
February 16, 2012

• Court Rules Dual Eligible Days Properly Included in Medicaid Fraction of Medicare DSH Calculation
• CMS Issues Proposed 60 Day Repayment Rule

Payment Matters
January 25, 2012

• CMS Instructs Teaching Hospitals on Reporting FICA Tax Refunds for Medical Residents
• CMS Proposed Rule May Offer Relief to Medicaid DSH Providers
• Second Year of the Medicare Primary Care Provider HPSA Bonus Payment Policy

Health Law Alert
2012: Issue 1 – Focus on HIPAA/Privacy

• Uncertainty Regarding eRx Hardship Exemption Requests to Continue in 2012
• Is Your Research Data Safe? Aligning HIPAA and the Common Rule
• HIPAA Considerations in Evaluating Cloud Computing
• California (and Texas) Increase Privacy Requirements
• Texas (and California) Increase Privacy Requirements
• Getting Paid Faster and Easier: New HIPAA Electronic Transfer Standards Rule

Payment Matters
January 11, 2012

• Independence at Home Demonstration: Testing In-Home Primary Care Services
• FY 2012 Wage Index Appeals Due Soon
• Bundled Payment Application Deadline Extended until April
• Sunshine Proposed Rule Sheds Light on Reporting Requirements

Payment Matters
December 20, 2011

• Prepayment Review: CMS Signals Changes that May Be in Store for the Recovery Audit Contractor (RAC) Program
• Welcome Clarification for Home Health Face-to-Face Documentation Requirements
• Quality Measures Under Consideration for Agency Programs
• Final Rule on ESRD PPS and Quality Incentive Program Issued

Health Law Alert
2011: Issue 7 – Focus on Antitrust

• Final ACO Antitrust Enforcement Statement Won’t Deter Procompetitive ACOs
• The Noerr-Pennington Exemption: Freedom to Stifle Impending Competition — Maybe
• DOJ Steps Up Antitrust Enforcement Against Health-Plan/Provider Restraints on Competition
• The FTC’s Interpretation of the State-Action Exemption
• Five Things Directors of Nonprofit Health Care Providers Can Learn from Lemington Home
• What Every Hospital Should Know Before Implementing a Mandatory Flu Shot Policy
• Participants in Medicare Part C and Part D May Now Be Considered Federal Contractors and Subcontractors
• Providers Benefit from False Claims Act’s First-to-File Rule

Payment Matters
November 29, 2011

• CMS Final Rule Eliminates Requirement for Signed Laboratory Requisition: The Good, the Bad and the Unknown
• Are You up for the Health Care Innovation Challenge? $1 Billion in Grant Money Announced
• Medicare Catch-22: Licensure Conundrum under DMEPOS Competitive Bidding
• OIG’s 2012 Work Plan – What Can Long-Term Care and Community-Based Providers Expect in the Coming Year?

Payment Matters
November 9, 2011

• CMS's New Application of an Old Policy: The Three-Day Payment Window and Wholly Operated Physician Practices
• CMS Provides Further Adjustments to Hospital Outpatient Supervision Rules
• CMS Releases Calendar Year 2012 Physician Fee Schedule Final Rule with Comment Period
• Calendar Year 2012 Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Final Rule Released by CMS

Payment Matters
October 27, 2011

• OIG's 2012 Work Plan - What's in it for Hospital and Physician Providers?
• Federal Pre-Existing Condition Insurance Plan Broadens Access to Uninsured Individuals

Health Law Alert
2011: Issue 6 – Focus on Long Term Care

• Seeking Shelter During Uncertain Times: Assessing the Federal Quality Assurance Privilege
• Administrative, Actuarial and Regulatory Hurdles Are Too Much for the CLASS Act
• Maryland's Medical Orders for Life-Sustaining Treatment Form Delayed
• Consultant Pharmacist - Is Independence Necessary?
• Five Lessons Learned (the Hard Way?) for In House Counsel

Payment Matters
October 13, 2011

• Many State Medicaid Agencies Require Providers to Perform Monthly Exclusion Checks
• Accreditation of Advanced Diagnostic Imaging Suppliers Must Be Completed by January 1, 2012

Payment Matters
September 28, 2011

• D.C. Appeals Court Provides Mixed Victory to Provider on DSH Calculation Involving Medicare Part C Days
• CMS Bundled Payment Initiative: An ACO Alternative?

Payment Matters
September 15, 2011

• CMS Wage Index Rules for FY 2012
• DME Competitive Bidding - Get Prepared for Round Two

Health Law Alert
2011: Issue 5 – Focus on Fraud and Abuse

• OIG Ceases Exclusion Efforts Against Forrest Labs CEO – Not All Corporate Officers
• OIG Warns That Arrangements Between CPAP Suppliers and Sleep Labs Pose F&A Risks
• Online Referral Service Proposes to Charge for Services, Raises OIG Concerns
• Metadata Standards for EHRs: A Sneak Preview of Meaningful Use Stage 2?
• CMS Provides Guidance on the Elder Justice Act’s Reporting Requirements
• Are Local IRBs Going the Way of the Dodo? Historic Proposed Changes to the Common Rule
• The FTC’s Interpretation of the State-Action Exemption

Payment Matters
September 1, 2011

• Hospitals Suffer Setback in IME Research Case
• CMS Proposes Medicaid Face-to-Face Requirements for Home Health and Medical Supplies and Equipment
• CMS Proposes Rules Impacting Expansion of Qualifying Physician-Owned Hospitals and Patient Notice Requirements
• CMS Delays Submission Deadline for Two Structural Measures Under Hospital Outpatient Quality Reporting Program to November 1, 2011

Payment Matters
August 18, 2011

• CMS Adopts IPPS and LTCH Payment Rates and Policies to Foster Quality-Based Improvements in Inpatient Care
• CMS Finalizes Quality Reporting Rules for IRFs and More Lenient Rules on Size and Square Footage for IRFs and IPFs
• CMS Issues GME/IME Resident Cap Adjustments

Payment Matters
July 27, 2011

• CMS Proposes Physician Payment Reductions for Services Within Hospital Three-Day Payment Window
• CMS Proposes Refinement of Outpatient Supervision Rules for Therapeutic Services
• CMS Proposes Ambulatory Surgical Center Quality Reporting – and Eventual Medicare Reimbursement Reduction – Rule
• CMS Proposes Community Mental Health Centers Conditions of Participation
• HIPAA - National 5010 Testing Days are Underway

Health Law Alert
2011: Issue 4 - Focus on HIPAA/Privacy

• HIPAA Audits Are Coming: KPMG Contracted to Perform 150 Audits Through 2012
• Why You Need to Worry AGAIN about HIPAA: Seven Practical Tips in the New Electronic Age
• Breach Reporting Plans: Practical Preparation for the (Almost) Inevitable Breach
• Corrective Action Plans Can Mean Significant Compliance Monitoring Requirements
• UCLA Resolves Privacy and Security Rule Violations

Payment Matters
July 14, 2011

• Calendar Year 2012 Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Proposed Rules Released by CMS
• CMS Releases its Calendar Year 2012 Physician Fee Schedule Proposed Rule
• CMS Proposes Rule on Signature on Laboratory Requisitions – A Trip Back to the Future
• Proposed Changes to the eRx Incentive Program – Too Little, Too Late?

Payment Matters
June 28, 2011

• Meaningful Use Deadline for Eligible Hospitals and Critical Access Hospitals is Approaching
• District Court Upholds Offset of Medicaid Revenue Against Amount of Allowable Provider Taxes for Medicare Purposes
• Streamlined Credentialing and Privileging Process Under the Final Telemedicine Rule
• Reminder: CMS Now Permits Electronic Submission of Medicare Graduate Medical Education (GME) Affiliation Agreements
• June 30 Deadline Looms for the Electronic Prescribing Incentive Program

Health Law Alert
2011: Issue 3 – Focus on Antitrust

• Some Practical Lessons from the ProMedica Hospital Merger Decision
• Timing and Hold Separate Agreements in Mergers: When to Fold, Hold or Call
• Accountable Care Organizations: More Guidance, but at what Cost?
• Dominant Hospitals, Dominant Insurers, and Exclusionary Conduct
• Early Retiree Reinsurance Program Compliance – Seven Ounces of Prevention

Payment Matters
June 10, 2011

• Quality Reporting for IRFs and More Lenient Rules on Size and Square Footage for IRFs and IPFs on the Horizon
• New Wage Index Occupational Mix Survey Data Due July 1
• CMS Proposes Rule Advancing Universal Access to Influenza Immunization

Payment Matters
May 26, 2011

• Hospital Pay-for-Quality Has Arrived: Final Value-Based Purchasing Rule Released
• CMS Tries to Breathe Life Back into ACO Program Through Three New ACO Initiatives
• Proposed Hospice Rule Tackles Aggregate Cap Calculation, Face-to-Face Encounter Rule and Quality Reporting
• Rehabilitation Agencies - Service Expansion No Longer Limited by Tier 4 Survey Status
• Health Information Standards Committee Seeks Comments on EHR Certification Program for Stage 2 of Meaningful Use

Payment Matters
May 13, 2011

• Quality & Efficiency: Key Themes in the Fiscal Year (FY) 2012 IPPS Proposed Rule
• FFY 2012 IPPS Proposed Rule Would Eliminate Hospice Data from the IME and DSH Calculations, and Would Modify the ESRD Add-On Payment Calculation
• Stay Tuned for Changes to CMS 855 Enrollment Forms
• New Information Technology Grant Funding Opportunity for Existing Rural Health Networks

Health Law Alert
2011: Issue 2 – Focus on Long Term Care

• Compliance with the Elder Justice Act's Reporting Requirements: Cautionary Tactics in the Face of Continuing Uncertainty
• Final Rule Modifies Civil Money Penalties Process for Nursing Facilities
• Prior Regulatory Approval of DMEPOS Supplier Defeats FCA Action
• Update of Maryland’s Health Care Facility Licensing Regulations Under Way

Payment Matters
April 28, 2011

• CMS Capitulates, Issues Ruling Granting Relief in Hospice Cap Challenges
• CMS Releases Proposed FFY 2012 IPPS Rule
• Federal Health IT Strategic Plan Available for Comment
• CMS Sign-Off - No Enforcement of Physician Signature Requirement on Lab Requisitions
• Primary Care Providers and General Surgeons Benefit from Increased Medicare Reimbursement

Payment Matters
April 14, 2011

• Rolling Back the Clock on DMEPOS Supplier Standards
• CMS Contractors Disallow Pension Costs in FFY 2012 Wage Index, Finding Pension Plans Overfunded in 2008
• Attestation System for Medicare EHR Incentive Program Opens on April 18, 2011
• Medicare Enrollment Application Fees

Payment Matters
March 29, 2011

• Recent GME/IME Case: Proceed with Caution in Use of Stipulations

Health Law Alert
2011: Issue 1 – Focus on Fraud and Abuse

• First Settlement Under the Voluntary Self-Referral Disclosure Protocol
• Valuing Non-Competes: The Bradford Decision
• New Long-Term Care Facility Closure Notice Requirements Go Into Effect March 23rd
• Incentive Payments Available for Geriatric Medicine Services

Payment Matters
March 10, 2011

• CMS Proposes Rule for Medicaid Nonpayment in the Event of Health Care Acquired Conditions
• HHS Office of Civil Rights Levies First Civil Money Penalty for Violations of the HIPAA Privacy Rule - $4.3 Million
• CMS Issues Its Second Billing Compliance Newsletter for Fee for Service Providers and Suppliers
• Two More Courts Invalidate CMS’s Regulations for Calculating Hospice Cap

Payment Matters
February 22, 2011

• D.C. Circuit Wage Index Decision Highlights Importance of Comments Made During Rulemaking
• OIG Releases Recovery Act Work Plan Including Plans for Meaningful Use, ONC, and REC Monitoring
• CMS Begins Reprocessing of Claims Required by the Affordable Care Act and the 2010 Medicare Physician Fee Schedule Changes
• CMS Open Door Forum to Address Home Health Value-Based Purchasing Set for February 24

Payment Matters
February 9, 2011

• Increased Scrutiny to Obtain and Maintain Medicare and Medicaid Enrollment – Final Regulations Published
• Rewarding Quality? Not Exactly - CMS Proposes Value-Based Purchasing Rule
• Can We Use 340B Drugs for…? New Answers on the Horizon

Payment Matters
January 26, 2011

• February 12, 2011 Deadline to Protest FY 2011 Wage Index Data
• Supreme Court Upholds IRS Rule that Hospitals Must Pay FICA Taxes on Resident Stipends
• HIT Policy Committee Releases Proposed Stage 2 (and Stage 3) Meaningful Use Requirements; Requests Public Comment
• CMS Implements Value-Based Payment System for Dialysis Facilities

Payment Matters
January 14, 2011

• Registration for the Medicare and Medicaid EHR Incentive Programs Opened January 3, 2011
• Red Flag Enforcement Delay Expired January 1, 2011; No Clarification Yet From FTC
• CMS Seeks Comments on Applicability of EMTALA to Hospital Inpatients and to Hospitals with Specialized Capabilities
• OIG Reports Ambulatory Surgical Centers Incorrectly Billed for Skilled Nursing Facility Bundled Services

Payment Matters
December 22, 2010

• Final In-Office Ancillary Service Exception Disclosure Requirements to Take Effect January 1, 2011

Payment Matters
December 9, 2010

• CMS Releases Final Rule for IME/GME Provisions in the Health Care Reform Legislation
• Congress Passes Legislation Exempting Health Care Providers from “Red Flags” Rule
• Say Goodbye to Physician-Owned Hospitals
• Physicians Note: PQRI Is Now PQRS

Health Law Alert
2010 Volume 2

• DEA Restates Position on Authorized Prescriber Use of Agents in Long Term Care Facilities
• HIPAA: The New Enforcement Culture
• Physician Payment Sunshine Act

Payment Matters
November 18, 2010

• CMS's Outpatient Supervision Rules – A Moving Target
• Therapy Changes, Face-to-Face Encounter Provisions and Enrollment Changes are Highlights of CY 2011 Home Health PPS Final Rule
• Deficit Reduction Commission Recommends Cuts to Federal Health Care Costs

Payment Matters
November 4, 2010

• OIG’s 2011 Work Plan – What Can Long-Term Care and Community-Based Providers Expect to See in the Coming Year?
• Medicaid RAC Cometh
• CMS Announces Access to Medicare DSH Eligibility Data
• CMS Releases Final Rules for Outpatient PPS, Physician Fee Schedule, and Home Health PPS and Home Health/Hospice Certification

Payment Matters
October 21, 2010

• OIG'S 2011 Work Plan - What's In It For Hospital and Physician Providers?
• CMS Releases FY 2012 Wage Index Public Use Files
• New Compliance Tool from the Centers for Medicare and Medicaid Services

Payment Matters
October 7, 2010

• Increased Scrutiny to Obtain and Maintain Medicare and Medicaid Enrollment – Time to Comment is Now
• OIG Publishes FY 2011 Work Plan

Payment Matters
September 22, 2010

• CMS Continues to Expand Reach of RHQDAPU Program in FY 2011 Rule to Include Hospital Acquired Conditions (HACs)

Payment Matters
September 10, 2010

• Court of Appeals Rules for Hospital in IME Research Case: The Battle Continues
• DMEPOS Suppliers Beware – Operational Changes May Be Required to Avoid Revocation

Payment Matters
August 27, 2010

• Is She a “Resident” or a “Billing Physician”? CMS Issues Needed Clarification

Payment Matters
August 13, 2010

• CMS Proposes Additional Changes to the Outpatient Physician Supervision Requirements
• CMS Releases Final IPPS Rules for FY 2011 and Interim Final Rule on Three-Day Window
• New PPS for End Stage Renal Dialysis Facilities Effective January 1, 2011

Payment Matters
July 30, 2010

• CMS Releases Proposed Rule for IME/GME Provisions in the Health Care Reform Legislation
• CMS Clears Up Stark Deadline Confusion and Proposes Implementing Regulations for Whole Hospital and Rural Provider Stark Exceptions

Payment Matters
July 9, 2010

• Proposed CY 2011 Physician Fee Schedule Offers Glimpse of Changes to Come Under Health Care Reform
• Some Time to Adjust: CMS Proposes Disclosure Requirements for the In-Office Ancillary Services Exception
• CMS Delays Hospital Reporting of Disclosure of Financial Relationships Report
• Lack of Clarity: CMS Announces It Will Not Clarify the Definition of "Entity" Under Stark
• CMS Posts Proposed Outpatient PPS and ASC Rule

Payment Matters
July 1, 2010

• The DRG Window Becomes a DRG Wall
• CMS Posts Proposed Physician Fee Schedule Rule
• CMS Updates Its RAC Data

Payment Matters
June 24, 2010

• Yet Another Federal Court Rejects Hospitals' Claims For Inclusion of State-Only Medical Assistance Days in DSH Adjustment
• E-Health Subsidies: Not Just for Physicians Anymore
• Ober|Kaler Launches "Medicareforgeeks.com"

Payment Matters
June 10, 2010

• CMS Proposes a Policy Clarification Regarding Medicare Treatment of Medicaid Provider Taxes
• CMS Continues to Refine RHQDAPU Program in FY 2011 Proposed IPPS Rule
• CMS Issues Proposed Rules Affecting The Medicare Wage Index

Payment Matters
May 13, 2010

• CMS Giveth and Taketh Away: New CMS Ruling on Medicare DSH Payments
• CMS Issues Interim Final Rules Implementing PPACA's Enrollment, Documentation, and Ordering and Referring Requirements

Payment Matters
February 4, 2010

• District Court Reaffirms Decision in Favor of Hospitals that Split Costs for Training Residents at a Nonhospital Site
• Meaningful Use and Certified Electronic Health Record Technology Rules Unveiled

Health Law Alert
2010 Volume 1

• From the Chair
• Expanded Liability Under the False Claims Act
• Supreme Court: Appeal Deadline Applies in FCA Action Even If Government Has Not Intervened
• Unfiled Discovery Documents in Contract Action Not Public Disclosure Under FCA
• HITECH Act Breach Notification Rule Now in Effect, But No Sanctions Apply Until 2010
• Arkansas Court Enjoins Hospital's Use of Economic Credentialing Policy
• New York Medicaid Makes Compliance Program Mandatory

Payment Matters
January 21, 2010

• Eastern District of Michigan Rejects Secretary's Position on IME/Research Time and New Residency Programs
• Local Coverage Determinations Cannot Be Used to Limit Reimbursement for Medicare Covered Drugs
• Enforcement Deadline Looms for HITECH Security Breach Notification
• PEPPER Reports Are Back

Payment Matters
January 6, 2010

• IME Research Time Revisited: Court Requires CMS to Explain Criteria
• Physician Specialists Who Perform Consultation Services Can Expect Administrative Hassles Under the 2010 Physician Fee Schedule Final Rule

Payment Matters
December 18, 2009

• Will New RAC Documentation Limits Really Provide Relief?
• FFY 2010 Wage Index Appeals Due Soon
• CMS Finally Finalizes Medicare Claims Appeal Procedures

Payment Matters
December 3, 2009

• CMS Releases 2010 Payment Rules for Services Furnished in Hospital Outpatient Departments and Ambulatory Surgical Centers
• Home Health Agencies Face New Outlier Rules and Program Safeguard Provisions
• Court Finds No Right of Appeal Where Intermediary Refused to Reopen

Payment Matters
November 13, 2009

• OIG's 2010 Work Plan — What's Critical for Long-Term Care & Community-Based Providers
• Physician Fee Schedule Promises Significant Reimbursement Changes in the Coming Year

Payment Matters
October 29, 2009

• Revalidation Process — Do Not Lose Billing Privileges
• OIG Releases Its Fiscal Year 2010 Work Plan - What's on the Agenda for Hospital Providers?
• California Federal Court Rejects CMS's Method for Counting Available Beds for IME Adjustment
• Another District Court Rejects Hospitals' DSH Claims

Payment Matters
October 15, 2009

• Medicare DSH Reimbursement for Charity Care Dealt Another Blow
• CMS Allows Exceptions to Local Coverage Determinations

Payment Matters
October 1, 2009

• District Court of Michigan Deals Blow to Non-Hospital Site Provider Education
• New Fully Bundled Prospective Payment System for Renal Dialysis Facilities
• CMS Issues Final Rule Limiting Recoupment of Overpayments
• DC Appeals Court Upholds Secretary's Exclusion of CAH Data from Wage Index Calculation

Payment Matters
September 17, 2009

• Medicare Bad Debts - Providers Win One and Lose One in the Courts
• The Divide Continues: Illinois Court Rejects Secretary's Interpretation of IME Regulation to Exclude Research Time

Payment Matters
September 2, 2009

• Expensive Consequences: Failure to Report RHQDAPU Data Will Have Significant Impact Under FY 2010 Acute Care IPPS Rule
• New Ambulatory Surgery Center (ASC) Survey Process
• Lost Revenue, Overpayments and Harsh Sanctions — Updated CMS Enrollment Rules
• CMS Imposes Significant Limitations on "New" Medical Education Programs Qualifying for IME/GME Reimbursement
• Tips from the RAC Cave: "RAC Man and QIC Boy Wonder Unmasked"

Payment Matters
August 18, 2009

• Forget What I Said – Medicare Date of Service Rule May Not Require Separate Line-Item Claims for Pathology Services
• Tips from the RAC Cave: "Witnesses: Physicians vs. Patients"
• Advanced Imaging Services Take a Hit in CMS Proposed Rule
• Court Offers Mixed Decisions on Medical Education Reimbursement for Managed Care Patients

Health Law Alert
Summer 2009

• From the Chair
• OIG Announces Self-disclosure Changes
• Imaging Center Settlement Among Largest Under OIG's CMP Authority
• The Future of Physician In-office Diagnostic Testing
• Payment for Medicare Bad Debts at Collection Agency Still Uncertain
• New AdvaMed Code in Effect as of July 1
• FCA Case May Proceed Based on Stark, Anti-kickback Allegations
• Avoiding False Advertising Hassles for Health-related Businesses
• FTC's Positive Clinical Integration Advisory Opinion is Encouraging to Providers
• Justice Department Revises Charging Guidelines for Prosecuting Corporations

Payment Matters
July 31, 2009

• One Court Upholds Medicare "Written Agreement" Requirement for GME/IME
• Are You Prepared to Obtain Your Own PS&R Report?
• Enforcement Date for Red Flag Rules Delayed Until November 1st - Additional Guidance to be Released
• Tips from the RAC Cave: "Hearings: Telephone vs. Video"

Payment Matters
July 15, 2009

• CMS Proposes to Both Ease and Tighten Physician Supervision Requirements for Hospital Outpatient Services
• Medicare Payment for Consultation Codes to be Eliminated by CMS Proposed Rule
• Tips from the RAC Cave: "Pre-RAC Audits vs. RAC Preparation"

Payment Matters
July 1, 2009

• CMS Releases RAC Phase-In Strategy
• Medicare Permits Ambulatory Surgical Centers to Submit Claims for Services of Physicians and Practitioners
• Tips from the RAC Cave: "Interqual vs. Milliman"

Health Law Alert Special Supplement: OIG 2008 Advisory Opinions
Summer 2009

• OIG 2008 Advisory Opinion No. 08-01: OIG Approves Bulk Replacement PAP
• OIG 2008 Advisory Opinion No. 08-02: OIG Allows Honorary Charitable Donations
• OIG 2008 Advisory Opinion No. 08-03: OIG Approves Prompt-pay Discounts
• OIG 2008 Advisory Opinion No. 08-04: OIG Approves Free Trial Prescription Program
• OIG 2008 Advisory Opinion No. 08-05: OIG Approves Pharmaceutical Kiosks in Physician Offices
• OIG 2008 Advisory Opinion No. 08-06: OIG Rejects Free Labeling of Test Tubes, Collection Containers for Dialysis Facilities
• OIG 2008 Advisory Opinion No. 08-07: OIG Approves Gift Card Program
• OIG 2008 Advisory Opinion No. 08-08: OIG Okays ASC Joint Venture Between Hospital Corporation, Surgical Group
• OIG 2008 Advisory Opinion No. 08-09: OIG Approves Orthopedic Surgery/Neurosurgery Gainsharing Agreements
• OIG 2008 Advisory Opinion No. 08-10: OIG Disapproves Block Leases Between Physicians and Urologists
• OIG 2008 Advisory Opinion No. 08-11: OIG Approves Waiver of Cost-sharing Obligations in Clinical Trial
• OIG 2008 Advisory Opinion No. 08-12: OIG Okays Insurance Preauthorization Services
• OIG 2008 Advisory Opinion No. 08-13: OIG Approves Medigap Policy Discounts for Use of Preferred Hospital Network
• OIG 2008 Advisory Opinion No. 08-14: OIG Approves Motivational Incentives Offered by Substance Abuse Treatment Center
• OIG 2008 Advisory Opinion No. 08-15: OIG Approves Cardiology Gainsharing Agreement
• OIG 2008 Advisory Opinion No. 08-16: OIG Okays Gainsharing Agreement with Medical Staff
• OIG 2008 Advisory Opinion No. 08-17: OIG Gives Okay to PAP Administered by Internet-based Pharmacy
• OIG 2008 Advisory Opinion No. 08-18: OIG Approves County Fund for Payment of Cost-sharing Amounts
• OIG 2008 Advisory Opinion No. 08-19: OIG Okays Pay-per-call Advertising
• OIG 2008 Advisory Opinion No. 08-20: OIG Approves DMEPOS Consignment Closets
• OIG 2008 Advisory Opinion No. 08-21: OIG Approves Cardiology Gainsharing Agreement
• OIG 2008 Advisory Opinion No. 08-22: OIG Okays Part-time Physician Employment Arrangements

Payment Matters
June 12, 2009

• Five Things You Should Know About the Fraud Enforcement and Recovery Act of 2009
• Global Warning – Medicare Date of Service Rule May Require Separate Line-Item Claims for Pathology Services
• Your Chance to Tell the Government What Documents You Want to See
• Tips from the RAC Cave: "Outpatient Observation vs. Inpatient Admission"

Payment Matters
June 2, 2009

• CMS to Rescind Final "Clarification" of Medicaid Outpatient Hospital Services Definition
• CMS Proposes Changes to DSH Patient Day Count and IME Bed Count Calculations
• CMS's Proposed Rule on Hospitals' "New" GME Programs Would Restrict Reimbursement for Such Programs

Payment Matters
May 14, 2009

• CMS Publishes Inpatient Prospective Payment System (IPPS) FY 2010 Proposed Rule
• Providers' Outpatient Blended Rate Challenges Rejected
• CMS Miscalculated Hospitals' Wage Index by Improperly Including Short Term Disability Hours in Calculation
• Federal Trade Commission Delays Enforcement of the Red Flags Rule (Again) and Offers Some Hints as to What May Happen

Health Law Alert
Spring 2009

• From the Chair
• What Providers Must Know When Appealing RAC Audit Findings
• Will Online Medicare Enrollment Facilitate Processing?
• AHRQ Regs Create Patient Safety Organizations
• D.C. Circuit Ruling May Imperil Future Charity Care Days Litigation
• New CMS Regs, PRRB Rules Set Rights for Part A Appeals
• Significant Stark Changes in Final IPPS Rule
• Villafane Court Adopts Pragmatic Approach to Stark AMC Exception
• Allison Engine: A "Less Friendly" Environment for Qui Tam Plaintiffs - But How Much So?
• Fighting Back Against Whistleblowers
• The Rise and Fall of Medicare Secondary Payer Litigation
• Single Member LLCs - Not Always the Vehicle of Choice
• An Ounce of Prevention — IP Audits Are Good Medicine
• Credentialing, Peer Review Files Producible in Federal Tort Actions

Payment Matters
April 24, 2009

• Medicare Bad Debts: Recent District Court Decision Undermines CMS's Must-Bill Policy
• Surety Bonds and Accreditation: Is it Worth the Cost to be a DMEPOS Supplier?

Payment Matters
April 9, 2009

• Follow the Rules for Protested Amounts on Your Cost Reports or Lose Your Right to Appeal
• Deadline Approaches for Resolution of Baystate DSH/SSI Case
• For-profit Medicare Providers to Face 3% Tax Withholding from Medicare & Other Government Payments

Payment Matters
March 18, 2009

• California Court Orders Medi-Cal to Increase Medicaid Payments to Nursing Homes
• Medicare Administrative Contractor Awards Protested

Payment Matters
March 6, 2009

• CMS Instructs Medicare Contractors on Anti-Markup Limitations
• Opportunities for Additional Payments under Stimulus Bill

Payment Matters
February 19, 2009

• CMS Expands Off-Label Prescription Drug Use for Cancer Treatment
• RAC Program Resumes

Payment Matters
February 6, 2009

• CMS Issues New Q&A That Permits Per-Service Lithotripsy Arrangements With Hospitals
• Final Guidance on "Never Events"
• Your Good Cause May Not Be Good Enough

Payment Matters
January 23, 2009

• CMS Announces Final Five Medicare MACs
• New Medicare-Certified Provider? Not So Fast – New Providers Continue to be Lowest Priority for State Survey Agencies
• Clarity Is Hard to Find: CMS's CY 2009 "Clarification" Regarding Physician Direct Supervision Requirement for Hospital Outpatient Department Services Raises More Questions than it Answers

Payment Matters
January 8, 2009

• Final "Clarification" of Medicaid Outpatient Hospital Services Definition Issued; Will be Challenged by AHA
• PEPPER Reports to Continue
• Makin' a Rule, Changin' it Twice: CY 2009 Physician Fee Schedule Further Modifies CY 2008 Changes to Diagnostic Test Billing Rules

Payment Matters
December 10, 2008

• First Circuit Adopts CMS' Interpretation of IME Regulation to Exclude Research Time
• Stock Transactions - Advance Notice and Approval?
• Incentive Payments Available to Successful Electronic Prescribers

Payment Matters
November 25, 2008

• Ninth Circuit Requires Documented Protested Costs or Risk False Claims Liability
• The OIG's 2009 Work Plan — What's in it for Long-term Care & Community-based Providers?
• Hopeful News for Providers on DSH/SSI Issue
• CMS Updates Home Health Payment Rates for CY 2009

Payment Matters
November 12, 2008

• CMS Postpones Deadline for Submission of Quality Data
• Battle of Bounty Hunters
• CMS Issues Final Outpatient PPS Regulations
• Changes in Medicare Payment, Billing and Enrollment Policies in the Final 2009 Medicare Physician Fee Schedule

Payment Matters
October 29, 2008

• Medically Unlikely Edits Now Available
• Failure to Respond to Information Request May Result in Revocation of Billing Privileges
• OIG Rolls Out its 2009 Work Plan - What Should Hospitals Be Aware Of?

Payment Matters
October 24, 2008

• FTC Delays Enforcement of "Red Flag" Rules Until May 1, 2009

Payment Matters
October 15, 2008

• PRRB - Oct. 20 Deadline to Add Issues and Recent Alerts
• CMS Releases Final Rule Limiting the Duration of Non-Random Prepayment Complex Medical Review
• CMS Announces New RACs and Revisions to the RAC Program
• CMS Publishes FY 2009 Final Wage Indices and IPPS Rates

Payment Matters
October 2, 2008

• Practitioners Get Relief from DMEPOS Accreditation Requirements
• Health Care Providers May Be Required to Take Action Against Identity Theft "Red Flags"
• CMS Releases New Rules Limiting Recoupment Pending Claims Appeals
• Delinquent Tax Payments - IRS Sharpens Its Collection Tools

Payment Matters
September 17, 2008

• Don't Miss Deadline for Adding Issues to Pending PRRB Appeals (Generally, October 20, 2008)
• CMS Issues FY 2010 Hospital Wage Index Development Timetable

Payment Matters
September 5, 2008

• CMS Issues Final EMTALA Provisions for FY 2009 - Two Significant Changes from Proposed Rule
• Final FY 2009 IPPS Rule Addresses Wage Index Issues
• Revised Guidance on Signature Stamps Leaves Unanswered Questions

Payment Matters
August 21, 2008

• PRRB Issues New Rules, Effective August 21, 2008
• CMS' Do-Not-Pay List Continues to Grow
• CMS Adds Thirteen New Quality Measures for Reporting in the Hospital Quality Data Program
• Kyphon, Inc. Settles Fraud Allegations; Hospitals Next in the Government's Sights?

Payment Matters
August 21, 2008

• PRRB Issues New Rules, Effective August 21, 2008
• CMS' Do-Not-Pay List Continues to Grow
• CMS Adds Thirteen New Quality Measures for Reporting in the Hospital Quality Data Program
• Kyphon, Inc. Settles Fraud Allegations; Hospitals Next in the Government's Sights?

Payment Matters
August 6, 2008

• Final IPPS Rule Contains Significant Stark Changes
• CMS Releases Final IPPS Rule for FY 2009
• Act Now or Risk Losing Ability to Bill for Services Prior to Obtaining Medicare Enrollment
• Be Careful What You Assume: CMS Issues Latest Clarification of Physician Supervision Rules in Hospital Outpatient Departments
• CMS Issues Proposed Outpatient PPS/ASC Payment Update

Health Law Alert
Summer 2008

• From the Chair
• Voluntary Disclosure Program: OIG Stats
• Deferred Prosecution Agreements with Device Manufacturers
• OIG Reviews Relationship Between CAH, Radiologists
• OIG Advisory Opinions
• OIG's 2008 Work Plan Focuses on Medicare Advantage & Part D
• Certain "Never Events" No Longer Payable
• HIPAA Security Assessments
• Notifying Patients of Medical Information Security Incidents
• No Longer Final: CMS Proposes Review of Some DAB Decisions
• Deal Revised Post-recruitment Falls Out of Stark Exception
• In-house Counsel and Compliance Director Faces FCA Action
• Caremark Settles with 28 States and District of Columbia
• Economic Stimulus Act Creates Bonus Depreciation, Increases Expensing Limits
• Patent Law Reform and the Health Care Lobby
• General Hospitals' Responses to Specialty Facilities: Competition or Exclusion? (Part 2)
• A Wake Up Call: The SSA "No-Match" Letter and the Safe Harbor Rule
• Employee Personal Protective Equipment-Who Pays?
• WellPoint Sued for Alleged FLSA Violations

HLA Special Alert
August 2008

• Stark Provisions in 2009 Inpatient Prospective Payment System Rule Will Lead to Major Changes for Physician Joint Ventures

Payment Matters
July 23, 2008

• Deadline to Appeal Reduction in Annual Payment Update for FFY 2008 Under RHQDAPU is Fast Approaching
• Are You At Risk For Losing Your Medicare Billing Privileges?
• Top Ten Things You Need To Know About Medicare Claims Appeal

Payment Matters
July 10, 2008

• CMS Proposes Bold Changes for the 2009 Medicare Physician Fee Schedule
• Proposed Changes to Anti-markup Prohibition Leave Providers of Diagnostic Services in a Quandry
• Proposed Rule Requires Physicians and Non-Physician Practitioners to Enroll as IDTFs
• Watch for E-mails from the PRRB

Payment Matters
June 26, 2008

• D.C. Appeals Court Reverses Favorable Decision on Charity Care Days in Adena Regional Medical Center v. Leavitt
• CMS Issues a Rash of LTCH Rules
• Bill Introduced to Fund Grants for U.S. Trauma Centers

Payment Matters
June 11, 2008

• CMS Adopts Final Rule Addressing Part A Appeals Before Intermediaries and the PRRB
• CMS Adds IDTFs to Payment Manual
• D.C. District Court Rules Moratorium Laws Prohibit CMS from Changing its Bad Debt Policy to Disallow Bad Debts Claimed While Still at a Collection Agency
• Beware of Overpayments in a CHOW Situation
• CMS Note to Providers on FY 2006 DSH/SSI Ratios

Payment Matters
May 28, 2008

• Final PRRB Rules Issued
• CMS "Clarifies" Bad Debt Policy Related to Claiming Bad Debts While Accounts Are at a Collection Agency, Removing Benefit of Moratorium
• Federal Court Dismisses Challenge to "Anti-Markup" Rule

Payment Matters
May 15, 2008

• Pathology Payment Issues
• Disclosure of Financial Relationships Report (DFRR): CMS Proposes Mandatory Reporting of Hospitals' Financial Relationships and Solicits Comments on Proposed Rule
• Hospital Emergency Services Under the Emergency Medical Treatment and Labor Act (EMTALA)
• CMS "Manualizes" Incident to Rules

Payment Matters
May 1, 2008

• If At First We Don't Succeed... CMS Seeks Comments Regarding Self-Referral Provisions in FY 2009 Hospital IPPS Proposed Rule
• Proposed Changes to the Hospital Wage Index

Payment Matters
April 18, 2008

• D.C. District Court Rules in Favor of Baystate in DSH/SSI Decision
• April 21, 2008 Deadline to Protest FY 2009 Wage Index Data
• CMS Releases Proposed IPPS Rule for FY 2009

Payment Matters
April 2, 2008

• No NPI Means No Payment Income
• PRRB Has Jurisdiction Over Costs Not Claimed By Provider On Its Cost Report

Payment Matters
March 18, 2008

• Government Reaches $666 Million Settlement in Medicare Reimbursement Case
• New ABN Form Adopted By CMS
• Recent Medicare Bad Debt Cases
• April 1 Deadline Approaches for Tamper Resistant Medicaid Prescriptions

Payment Matters
March 5, 2008

• CMS Creates a Process for Prior Medical Necessity Determinations
• Suppliers Beware: The OIG Estimates That Over $125 Million in Potential Overpayments Were Made on Behalf of Beneficiaries in Part-A Covered SNF Stays

Payment Matters
February 20, 2008

• Final Part A Reimbursement Appeal Regulations Expected Soon
• Insurers Agree to Pay for Online Visits with Physicians
• Interpretive Guidelines for Hospital CoPs Issued

Payment Matters
February 6, 2008

• Another Step Designed to Reign in Unscrupulous DMEPOS Suppliers
• Provisions in the Paper-based Manual Omitted from Internet-only Manuals May Still Be Good Policy

HLA Special Alert
February 2008

• Big Changes to Physician Diagnostic Testing Under 2008 Medicare Physician Fee Schedule

Payment Matters
January 23, 2008

• Victory for IRFs, Mixed Bag of Relief and Scrutiny for LTCHs
• CMS' Reliance On Unpublished Payment Principles Rejected by Federal Court
• Private Payers Refusing to Pay for "Never Events"

Payment Matters
January 9, 2008

• Physicians Convince CMS to Delay Implementation of Anti-markup Rule Pending Further Study
• Significant Changes Proposed for DAB
• U.S. District Court Enjoins CMS from Implementing Average Manufacturer Price Rule for Medicaid Reimbursement
• Outpatient Quality Reporting Deadline: January 31, 2008

Payment Matters
December 19, 2007

• Hospital Outpatient Departments Will Be Required to Use NDC Code for Outpatient Drugs Billed to Medicaid Beginning January 1, 2008
• Final Changes and Updates to CMS's Revised ASC Payment System
• Payment for Preventive and Screening Services for SNF Residents

Payment Matters
December 4, 2007

• RAC Attacks: News From the Front
• CMS Adds to List of Medicare Telehealth Services
• Physician Fee Schedule Payments Now Require 9-Digit ZIP Codes for Place of Service

Payment Matters
November 12, 2007

• CMS Issues Final Policy and Payment Changes for Hospital Outpatient Services
• CMS Delays Certain Stark Provisions
• Mandatory Hospice Detail Billing Compliance Date Moved to July 1, 2008

Payment Matters
November 8, 2007

• CMS Unveils 2008 Physician Fee Schedule
• CMS Puts Clinical Trial Policy On Hold Again
• Requests for Approval for All Hospital Transplant Programs Due by December 26

Payment Matters
November 5, 2007

• SPECIAL ALERT: Far Reaching Implications for Physician Diagnostic Testing Arrangements Under the 2008 Physician Fee Schedule Rule

Health Law Alert
Fall/Winter 2007

• From the Chair
• Stark II, Phase III Final Regulation: Changing the Compliance Landscape
• 2008 Physician Fee Schedule Looks at Physician Self-referral
• Seven Things You Need to Know About the New Form 990
• FTC Approves Joint Contracting in Clinical Integration Program
• General Hospitals' Responses to Specialty Facilities: Competition or Exclusion? (Part 1)
• 2nd Circuit Rejects HHS's Investigational Device Coverage Policy
• Billing for Unused Biologicals
• OIG/AHLA's Third Resource Guide Focuses on Health Care Quality
• Home Care and Child Care Providers May Unionize in Maryland
• Recent SEC Developments
• DOJ Speaks to Wage Status of Radiology Technologists

Payment Matters
October 24, 2007

• CMS Issues FY 2009 Hospital Wage Index Timetable
• RAC Attack
• More Detail Required for 2008 Hospice Claim Data

Payment Matters
October 10, 2007

• OIG Rolls Out its 2008 Work Plan: What Should Providers Be Aware Of?
• OIG Approves Hospital's Payments to Physicians for On-Call Services
• Two or Three Times May Be the "Charm" in Correcting Deficiencies. But It Will Also Be Costly

Payment Matters
September 27, 2007

• To Err is Human. But It Won't Get Paid: Denial of Medicare Payment for Hospital-acquired Conditions
• Physician-owned Hospitals Required to Provide Notice to Patients
• CMS Clarifies SNF Billing Requirements for Beneficiaries Enrolled in Medicare Advantage ("MA") Plans

Payment Matters
September 14, 2007

• Final FY 2008 Home Health Prospective Payment Refinement and Rate Update
• Providers May Charge For Missed Appointments, But.
• Claiming Medicare Bad Debts

HLA Special Alert
September 2007

• 2008 Medicare Physician Fee Schedule Stark Physician Self-Referral Provisions & Related Policy Changes

HLA Special Alert
September 2007

• Stark II, Phase III Final Regulation: Changing the Compliance Landscape

Payment Matters
August 29, 2007

• Reporting Extension Locations Updating the 855
• CMS Publishes Final Skilled Nursing Facility PPS Rule
• Updating the Medicare Clinical Trial Policy: One More Time...

Payment Matters
August 15, 2007

• CMS Issues Final FY 2008 IPPS Rate and Policy Changes
• Hospital's Failure to Conduct Coordination of Benefits Gives Rise to Qui Tam Settlement
• CMS Alters Medicare Payment Structure for ASCs

Payment Matters
July 31, 2007

• CMS Extends Time for Publication of the Much Anticipated Final PRRB Rule
• Good News and Bad: A Look at the Proposed 2008 Physician Fee Schedule
• CMS Issues Proposed Policy and Payment Changes for Hospital Outpatient Services

Health Law Alert
Summer 2007

• From the Chair
• Advisory Opinion on Sale of Ownership Interests Raises Questions
• E-prescribing and Electronic Health Records Protection
• Physician Investments in Medical Device Industry
• OIG Advisory Opinions
• New Enrollment Regulations: Protect Your Current Medicare Participation
• Behind the Scenes: Drug Company Patent Infringement Settlements
• FY 2007 Wage Index and the Occupational Mix Adjustment
• Medical Education Under Medicare: Confusion over Didactic Time
• Final DMEPOS Quality Standards
• CMS Plan Focuses on Physician Ownership in Specialty Hospitals
• OIG Guidelines for Evaluating State False Claims Acts
• Rule 9(b) Does Not Require Pleading of Specific Claims
• Heed Insurance Coverage in Constructing and Renovating Health Care Facilities
• Planning to Charge a Yearly “Overhead” Fee? Proceed with Caution

Health Law Alert
Fall 2006

• From the Chair
• DRA Changes Medicaid Long-Term Care Eligibility
• DRA Efforts to Combat Medicaid Fraud
• OIG Advisory Opinions
• Open Letter Promotes Compliance, Self-disclosure
• Two Major DSH Decisions
• Power Mobility Devices Subject to New Payment Rules
• Durable Medical Equipment Suppliers Beware
• Compliance Guidance for PHS Research Award Recipients
• HHS Recognizes Value of Measured Approach to Enforcement in HIPAA Final Rule
• CMS Publishes Inherent Reasonableness Final Rule
• Bisig Widens Avenues of Recovery for FCA Relators
• Miami Hospital Excluded for Noncompliance with CIA
• Florida Fraud Statute Scrutinized Anew on Appeal
• Attorney Fee Recovery Under EAJA
• Efficiencies and Justifications for Physician Network Joint Contracting
• Recent Developments Affecting Employee Benefit Plans

Health Law Alert
Spring 2006

• From the Chair
• New Law Creates National Patient Safety Database
• OIG Focus: Part D, Nursing Homes and CMS
• Safe Harbor Proposed for Federally Qualified Health Centers
• OIG Advisory Opinions
• OIG Cites Antikickback Risks with PAPs Under Part D
• Nursing Staffing Data-posting Requirement for Nursing Facilities
• Providers Score a Victory in DSH Litigation
• CMS Relaxes Marketing Rules to Promote Part D Enrollment
• Hospitals Face Increased Risks for Improper Discharge Coding
• CMS Issues First Stark Advisory Opinion in 7 Years
• More Courts Support FCA Actions Based on Kickbacks
• First-to-file Bar Held Inapplicable to Qui Tam Suits
• Landmark Clausen Decision Reaffirmed
• Proposed Rule Allows Waiver of Exclusion
• Erlanger Resolves Scrutiny of Its Physician Relationships
• Michigan Hospital Settles Voluntary Disclosure of Physician Relationships
• Federal Government Settles Investigation of AdvancePCS
• When is a Home Health Agency Not a Home Health Agency?
• Full-system Contracting: Business as Usual or Antitrust Time Bomb?
• Stark, Antikickback Protection for E-prescribing, EHR
• More Specificity in Informed Consent

Health Law Alert
Fall 2005

• From the Chair
• CMS Delays CAP
• OIG Advisory Opinions
• More GME Guidance on Nonhospital Sites
• GAO Reviews First Year Under Privacy Rule
• Medicare Appeals Process Overhauled
• CMS Issues Draft Coverage Guidance
• Proposed Changes to PRRB Appeals Procedures
• DHS CPT Codes to Include Nuclear Medicine
• FCA's Statute of Limitations Does Not Apply to FCA Retaliation Claims
• No Damages Element for False Claims Conspiracy
• Univ. of Alabama Settles Research Qui Tam Suit
• Don't Buy That Extra Shredder Just Yet: Document Retention After Andersen
• Florida Fraud Statutes Questioned
• Complications on the Horizon for Health System Parent Entities
• DOJ/FTC Report on Antitrust in Health Care

Health Law Alert
Fall/Winter 2004

• From the Chair
• Hospital Discounts to Uninsured Patients
• OIG Advisory Opinions
• OIG Alert: Added Charges for Covered Services
• Unsolicited/Voluntary Medicare Refund Requirements
• Hospital "Credentialing" of Nonphysician Employees
• The Evolution of Risk Management to Corporate Compliance and Beyond
• Medco Settlement Excludes FCA Claim Citing Compliance Plan Deficiencies
• CMP Rule, Guidance Set Gauge for Drug Card Sponsors
• OIG Updates Hospital Compliance Program Guidance
• AdvaMed Code Curtails Lavish Spending
• CMS Proposes Changes to Reimbursement Appeal Rules
• Revised Policies Affect Direct Deposit Medicare Funds
• New Changes to Medicare Medical Education Rules
• FY 2005 Wage Index: Where Are You Now?
• CMS Sets Criteria for Specialty Hospital Moratorium
• New EMTALA Guidance
• EMTALA Compliance - Practical Considerations
• First Circuit: Rule 9(b) Applies to FCA Actions
• Standard for Dismissal Misapplied in Qui Tam Case
• Government Required to Exhaust Administrative Remedies in Non-FCA Case
• University of Washington PATH Settlement is Largest Yet
• Fraud Statute Unconstitutional
• Beyond Saber Rattling: Congress Threatens Aggressive Regulation of Nonprofits
• Consider Broker-Dealer Compliance in Stock and Securities Sales

Health Law Alert
Spring/Summer 2004

• From the Chair
• Is the Medicare Advantage Program a Disadvantage for Providers?
• OIG Advisory Opinions
• OIG Focus: HHS Vulnerabilities
• Outpatient Therapy Physician Visits
• CMS Web-based Manuals
• Focus on DME Fraud
• Contracting for Non-hospice Services
• Meeting Resident Needs: Trained Feeding Assistants
• AstraZeneca Pharmaceuticals Settles
• Interesting MMA Issues for NPs
• Broader Corporate Sentencing Guidelines Coming
• Notes from the HIPAA Enforcement Road
• New Confusion in GME/IME Off-Site Training Rules
• IRFs Challenged by Revised 75 Percent Rule and Medical Necessity Guidelines
• Revised Coverage Determination Procedures
• Medicare Signature Requirements
• New EMTALA Rules Good News and Bad
• Prior Authorization Requirements and the EMTALA Final Rule: Progress?
• No FCA Intent When Acting on Muddled Billing Guidance
• HIPAA "Health Care Fraud" Interpreted
• Criminal Fine Apportioned to Indigent Medical Care Programs
• Abbott Labs Resolves DME Fraud Charges
• Good Works Do Not Reduce Fraud Sentence
• A View from the Inside
• How to Structure Your Next Equipment Lease

Health Law Alert
Fall/Winter 2003

• From the Chair
• Contractual Joint Ventures Scrutinized Anew
• OIG Tackles Discount Issues
• Beware of Misuse of "Medicare" in Marketing Practices
• OIG States Position on DME Telemarketing
• OIG Advisory Opinions
• Final Outlier Rule to Curb Abuses
• Proposed Medicare Enrollment Rule
• Group Therapy: Seeing Through the Murky Water?
• Security Issues for Long Term Care Providers
• NPIA Exempts Resales to Hospital Workers
• Compliance Guidance for Pharmaceutical Manufacturers
• Earlier Wage Index Deadlines in Place
• Provider-based Rules Take Effect
• "Person" Under FCA Varies - Even in Same Case
• Contractual Remedy Precludes FCA Liability
• Courts Interpret "Public Disclosure" Bar of Qui Tam Suits
• Hospital Pleads Guilty After Ignoring Fraud
• "Lick and Stick" Allegations Yield Nation's Largest Medicaid Fraud Settlements