On Nov. 29, 2018, Deputy Attorney General Rod J. Rosenstein announced several amendments to policies on individual accountability set forth in the 2015 Yates Memo. As a result, companies facing FCA actions—especially defendants in health care cases—should consider following three strategy tips:  (1) Establish clear benchmarks for cooperation.  (2) Advocate for individual releases.  And (3) Emphasize that litigation costs outweigh the potential recovery in appropriate cases. To learn more please read this Bloomberg BNA article…

On January 1, 2019, portions of the U.S. Department of Labor’s (DOL) Final Rule expanding the availability of Association Health Plans (AHPs) went into effect. AHPs allow small businesses to band together and negotiate better deals when buying insurance for their members. The partial government shutdown hasn’t slowed the raging debate over how states are to implement the DOL’s final rule. On December 28, 2018, a federal judge ordered litigation concerning the rule to continue…

  More of our health information is becoming digital every day, as new technology companies enter the health care and wellness markets. Many companies that hold a wealth of consumer health information are not covered by HIPAA. Many consumers may not realize that their health information only is protected and they only have certain rights with respect to that information when it is held by certain entities, but not when it is held by others.…

The New York State Attorney General (the ”AG”) recently issued new standards of review for the sale of all or substantially all assets of not-for-profit nursing homes which should be of keen interest to both not-for-profit providers and prospective for-profit purchasers.  See http://www.charitiesnys.com/pdfs/NursingHomeSales.pdf (the “Guidance”). After noting the significant increase in efforts to sell nonprofit nursing homes to for-profit entities since 2014 in New York, the Guidance expresses “significant concern”  regarding the “effort and success” by…

The Centers for Medicare & Medicaid Services (CMS) recently proposed a rule to allow Medicare Advantage plans to expand telehealth benefit coverage. (See alert for more detail) This proposed rule implements the statutory provisions in section 50323 the Bipartisan Budget Act of 2018. What you might not know, however, is that the Bipartisan Budget Act of 2018 is only one of many legislative vehicles by which advocates for telehealth expansion have been able to move…

In its recent notice of proposed rulemaking setting policy for Medicare Advantage (MA) and the Prescription Drug Program (PDP) for calendar year 2020, CMS announced that it would establish extrapolation as a method to be used in risk adjustment validation (RADV) audits, and further, that it would not make any adjustments to account for errors in Medicare fee for service data in determining recovery amounts. CMS uses a risk adjustment process to modify MA plan…

This blog post has been prepared in collaboration with Nemours. Ms. Boyer is a Manager of Nemours Children’s Hospital. Maya Upplauru is an associate in Crowell & Moring’s Health Care Group in Washington, D.C. This Bulletin is brought to you by AHLA’s Children’s Health Affinity Group, which is part of the Academic Medical Centers and Teaching Hospitals and In-House Counsel Practice Groups. One of the most fear-inducing experiences for new and first-time parents…