In this Issue
From the Chair
Guide to Terms
Congratulations
Ober|Kaler in Print
Legislation
DRA Changes in Medicaid Long-Term Care Eligibility
DRA Efforts to Combat Medicaid Fraud
OIG Activity
OIG Advisory Opinions
Open Letter Promotes Compliance, Self-disclosure
Hospitals
Two Major DSH Decisions
DME
Power Mobility Devices Subject to New Payment Rules
Durable Medical Equipment Suppliers Beware
Compliance
Compliance Guidance for PHS Research Award Recipients
Privacy
HHS Recognizes Value of Measured Approach to Enforcement in HIPAA Final Rule
Reimbursement
CMS Publishes Inherent Reasonableness Final Rule
FCA
Bisig Widens Avenues of Recovery for FCA Relators
Enforcement
Miami Hospital Excluded for Noncompliance with CIA
Litigation/ADR
Florida Fraud Statute Scrutinzed Anew on Appeal
Attorney Fee Recovery Under EAJA
Antitrust
Efficiencies and Justifications for Physician Network Joint Contracting
Employment
Recent Developments Affecting Employee Benefit Plans
Health Law Group
Sanford V. Teplitzky, Chair
Melinda B. Antalek
William E. Berlin
Christi J. Braun
Marc K. Cohen
Thomas W. Coons
John J. Eller
Joshua J. Freemire
Leslie Demaree Goldsmith
Carel T. Hedlund
S. Craig Holden
Leonard C. Homer
Thomas K. Hyatt
Julie E. Kass
Paul W. Kim
John F. Lessner
William T. Mathias
Robert E. Mazer
Carol M. McCarthy, Ph.D.
John J. Miles
Christine M. Morse
Patrick K. O'Hare
Leon Rodriguez
Martha Purcell Rogers
Laurence B. Russell
Donna J. Senft
Ray M. Shepard
Steven R. Smith
Howard L. Sollins
E. John Steren
Chiarra-May Stratton
Emily H. Wein
James B. Wieland
Editorial Assistant: Michele Vicente, Paralegal
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Ober|Kaler in Print
- For the third year in a row, Ober|Kaler's Health Law Department is
tied for first place in a peer-based ranking of Maryland health law practices
according to a survey released in Chambers USA, America's Leading
Business Lawyers, a compilation of the country's most widely recommended
lawyers and law firms that is generally considered the gold standard for
legal excellence.
- Nightingale's Healthcare News named Jim Wieland among ten
"Outstanding Physician Practice Lawyers 2006," a list culled from a
national pool of applications submitted by colleagues and peers.
- Julie Kass was named by Nightingale's Healthcare News as one of twelve
"Outstanding Fraud and Compliance Lawyers 2006."
- The 2007 edition of The Best Lawyers in America recognizes eight
attorneys from Ober|Kaler's Health Law Practice Group: Craig Holden,
Len Homer, Tom Hyatt, Patrick O'Hare, Marty Rogers, Howard Sollins,
and Sandy Teplitzky for their depth of experience and knowledge in Health
Care Law. Marty Rogers received a second nod for her work in White Collar Criminal Defense and Jeff Miles was selected for his work in Antitrust Law.
- Rob Mazer's article, "Why Don't Doctors Do It in the Office?" appeared
in the March/April 2006 issue of Maryland Bar Journal. The article
discusses the legal issues associated with the provision of diagnostic services
by medical practices.
- Look for Steve Smith's book, Understanding the Patient Safety and Quality
Improvement Act of 2005; Key Issues (American Health Lawyers
Association, Publisher) .available through www.healthlawyers.org.
- Sandy Teplitzky was featured as a Public Interest Donor in the June 2006
issue of AHLA's Health Lawyers News.
- Donna Senft's article, "Nursing Staffing Data — Posting Requirements
for Nursing Facilities," appeared in the January/February 2006 issue of
Geriatric Nursing.
- Rob Mazer's article discussing the OIG's April 2006 open letter to healthcare
providers, "OIG Urges Greater Use of Self-Disclosure Protocol," appeared
in the June 2006 issue of Washington G-2 Reports G-2 Compliance Report.
- Tom Coons co-chaired a working group of the AHLA's Public Interest
Committee to develop a Medicaid Consumer Information Fact Sheet,
a resource providing contact information for Medicaid offices across the country
to assist individuals in quickly and easily finding the Medicaid
information they need.
- Sandy Teplitzky and John Lessner's article, "HHS Recognizes Value of
Measured Approach to Enforcement in HIPAA Final Rule," appeared in
the April 3, 2006, CCH Health Care Compliance Letter.
- In the May 17, 2006 issues of BNA's Health Plan and Provider Report, Jeff
Miles was quoted from his May 12 presentation of "A Look at the Antitrust
Crystal Ball — What Might Be Coming" at the AHLA/AHIP Law
Conference for Health Plans, Insurers, and Providers, regarding the
FTC's decision in the Evanston Northwestern Healthcare hospital merger and
the possible resulting trends in upcoming antitrust enforcement action.
- Bill Berlin and Christi Braun's article, "Comparing and Contrasting the
FTC's North Texas Specialty Physicians Opinion with the Advocate
Arbitration Decision," appeared in the March 2006 issue of ABA's Antitrust
Health Care Chronicle.
- Leon Rodriguez was quoted by the Washington Post in the May 12, 2006,
article, "16 Weeks Come Down to 6 Hours; Lawyers in Enron Trial
Prepare for Closing Arguments," in which he discusses the difficulties
prosecutors face in meeting the burden of proof in a complex white collar
case.
- Sandy Teplitzky was quoted by Modern Healthcare in "Are Hospitals Next
in Line?" an August 14, 2006, article in which Sandy discusses the potential impact on hospital/physician relationships in light of the recent federal scrutiny of physician relationships with medical devicemakers. The article appeared again on August 22, 2006, in modernhealthcare.com.
- John Lessner's article, "HIPAA Checkups for Compliance," appeared in the March/April 2006, issue of Geriatrics Nursing. The article discusses those aspects of long term care providers' operations that require ongoing analysis and review to ensure continued HIPAA compliance.
- Bill Berlin and Christi Braun's article, "Efficiencies and Justifications for Physician Network Joint Contracting: The FTC's North Texas Specialty Physicians Opinion and Advocate Healthcare Arbitration Decision,"
appeared in the May 2006 issue of Health Lawyers News.
- Modern Healthcare quoted Jeff Miles in the June 26, 2006, article,
"Revival of the Fittest," in which he discusses the alternatives available to physician hospital organizations in their struggle to survive in the face of antitrust scrutiny.
- Baltimore Business Journal featured Paul Kim in "New Minority Bar President Commits to Fostering Diversity," an article in which Paul discusses his goals as President of the Asian Pacific American Bar
Association of Maryland.
- Part B News quoted Rob Mazer in the May 1, 2006, article, "Penalties
Accompany New Enrollment Requirements," in which she discusses the implications of CMS's definitions of delegated officials.
- Laboratory Compliance Insider quoted Leon Rodriguez in the March 2006
article, "Whistleblower Ruling Gives Hope to Labs," in which he comments on a U.S. district court's decision barring a former employee from bringing a qui tam suit alleging false Medicare claims because the employee's severance agreement had released his employer from any claims.
- Rob Mazer was quoted by the August 2006 Laboratory Compliance Insider
in "Use a Focused Review to Correct ABN Compliance Problems in the Laboratory," discussing solutions to laboratories' ABN-related reimbursement issues.
- Craig Holden and Paul Kim's article, "Due Diligence Review of
Manufacturers: Beyond Examination of Compliance Programs," appeared in AHLA's online newsletter, Health Lawyers Weekly.
- Laboratory Compliance Insider quoted John Lessner in the May 2006 article, "Here's What Happens When Providers Violate the Provisions of HIPAA," in which he discusses the government's approach to HIPAA
enforcement.
- Carel Hedlund was quoted by the April 28, 2006, .Home Health Line in
"New Provider Enrollment Rule Aims to Plug Information Gaps — But Less Frequently," an article in which Carel discusses the type of information required on the revised CMS-855 enrollment form.
and elsewhere.
- Tom Hyatt will copresent "Charity Care Developments" at AHLA's Tax
Issues for Healthcare Organizations.
- Craig Holden copresented "Conducting a Due Diligence Review of a Drug
or Device Manufacturer" at AHLA's Life Sciences Law Institute.
- Paul Kim was elected President of the Asian Pacific American Bar
Association of Maryland, a chapter of the National Asian Pacific American
Bar Association, and to a three-year term as a member of the DC Bar Health
Law Section Steering Committee.
- John Lessner was appointed President of the Board of Directors of Court Appointed Special Advocate (CASA) of Baltimore, an organization providing a voice for children in the juvenile justice system.
- Carel Hedlund and Donna Senft presented "Medicare's New Provider Enrollment Rules: New Requirements for Every Organization That Bills Medicare," an audio conference sponsored by DecisionHealth, publisher of Part B News, on July 11, 2006. The audio conference will be repeated by popular demand on September 21, 2006.
- Craig Holden will copresent "Advanced Stark" at the AHLA's Fraud & Compliance Forum. Bill Mathias will copresent "Compliance Challenges in the DME/HME Industry."
- Jeff Miles copresented "A Look at the Antitrust Crystal Ball — What Might Be Coming" at the Law Conference for Health Plans, Insurers, and Providers, sponsored by AHLA and America's Health Insurance Plans.
- Howard Sollins has been appointed to the University of Maryland at Baltimore School of Social Work Board of Advisors, where, according to the school's dean, he will add a "distinct and important perspective" as the Board strives to further the mission of the School.
- At the Health Care Compliance Association's April 2006 Compliance Institute, Sandy Teplitzky, Craig Holden, and Bill Mathias copresented "Fraud and Abuse Primer."
- Rob Mazer was a panelist in "The Maryland Self-Referral Statute — has anything changed?" presented before the Maryland State Bar Association's Health Law Section.
- Donna Senft presented "Managing the Other F-Word: New CMS F-Tag Guidance," a teleconference sponsored by Mountain-Pacific Quality Health Foundation.
- At the American Bar Association's National Institute on Health Care Fraud 2006, Craig Holden copresented "Workshop for Defense and Inhouse Counsel" and Sandy Teplitzky copresented "'Practicing Before the
OIG in an Era of Proactive Enforcement': Administrative Enforcement
Developments."
- At the AHLA's Fundamentals of Health Law program, Tom Hyatt will present "Tax Exemption and Tax Issues" and serve as a panelist on the "Legal Ethics Case Study: A Crash Course in the Interplay of a Lawyer's
Legal and Ethical Obligations When Doing Joint Ventures."
- The Maryland Legal Aid Bureau, Inc. has appointed Paul Kim to its Legal Justice Council.
- At the Virginia Health Care Association's program, Staying on the Road to Compliance: Regulatory and Operational Issues Facing LTC, Howard Sollins copresented "Survey and Certification Legal Issues Update"; Rob Mazer presented "New CMS F-Tag Guidance" and copresented "Fraud and Abuse Issues in Long-Term Care" with Leon Rodriguez; John Lessner presented "Admission Issues Following the Deficit Reduction Act" and copresented "Informal Dispute Resolution"; and Harold Belkowitz presented "Collection Issues for Long-Term Care Providers."
- Tom Coons has been elected to a second three-year term on the AHLA's Board of Directors.
Copyright© 2006, Ober, Kaler, Grimes & Shriver
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