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DOJ’s Recent Telehealth Enforcement Action Highlights Increased Abuse of COVID-19 Waivers

By Lauren Petrin

July 20, 2021

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On May 26, 2021, the Department of Justice (“DOJ”) announced a coordinated law enforcement action against 14 telehealth executives, physicians, marketers, and healthcare business owners for their alleged fraudulent COVID-19 related Medicare claims resulting in over $143 million in false billing.[1] This coordinated effort highlights the increased scrutiny telehealth providers are facing as rapid expansion efforts due to COVID-19 shape industry standards. Since the outset of the COVID-19 pandemic, the DOJ has prioritized identifying…

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Interoperability and Its Impact on Payors

By Karen Mandelbaum & Patricia M. Wagner

June 23, 2021

Only a few days remain before the enforcement delay that the Centers for Medicare & Medicaid Services (CMS) exercised due to COVID-19 will end and the agency will require certain payors to publish a Patient Access application programming interface (“API”) and a Provider Directory API under the requirements of the CMS Interoperability and Patient Access Final Rule. Starting on July 1, 2021, all health plans that offer Medicare Advantage, Medicaid and Children’s Health Insurance Program…

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Health Cos. Must Prepare For Growing Ransomware Threat

By Alaap B. Shah & Stuart M. Gerson

June 23, 2021

Worried,Businessman,Looking,At,Laptop,With,Ransomware,Word,On,The

Our colleagues Alaap Shah and Stuart Gerson of Epstein Becker Green have written an Expert Analysis on Law360 that will be of interest to our readers: “Health Cos. Must Prepare for Growing Ransomware Threat.” The following is an excerpt (see below to download the full version in PDF format): Ransomware attacks have become big business, and they are on the rise. And entities in the health care and life sciences space have become…

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Information Blocking – How Did I Become an “Actor”?

By Karen Mandelbaum & Patricia M. Wagner

June 22, 2021

Child,Safety,Online.,Little,Kid,Using,Laptop,At,Home.,Illustration

The roll out of the Office of the National Coordinator’s (ONC) 21st Century Cures Act Interoperability and Information Blocking Rules is reminiscent of the way HIPAA has rolled out over the course of the past 25 years. As of May 1, 2021, Actors have been required to comply with the Information Blocking rules. However, it will take some time before all Actors know who they are and for complaints of Information Blocking to be determined…

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Podcast: What’s New for Insurers in Mental Health Parity Compliance – Diagnosing Health Care

By Epstein Becker Green

June 10, 2021

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In this episode of the Diagnosing Health Care Podcast: The Departments of Labor, Health and Human Services, and the Treasury jointly released a set of frequently asked questions (“FAQs”) related to recent changes made to the Mental Health Parity and Addiction Equity Act effective as of February 10, 2021, and enacted by the Consolidated Appropriations Act at the end of 2020. Accordingly, health plans and insurers must ensure that they understand, and are prepared…

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U.S. Department of Justice Announces Interagency Task Force to Combat COVID-19 Relief Fraud

By George B. Breen, Erica Sibley Bahnsen, Daniel C. Fundakowski & Elizabeth Harris

June 10, 2021

On May 17, 2021, the U.S. Department of Justice (“DOJ”) announced the establishment of a COVID-19 Fraud Enforcement Task Force (“Task Force”) to ramp up enforcement efforts against COVID-19-related fraud.[1] Organized and led by Deputy Attorney General Lisa Monaco, the Task Force convened its first meeting on May 28 and aims to “marshal the resources of the [DOJ] in partnership with agencies across government to enhance enforcement efforts against COVID-19 related fraud.”[2] …

Health Law Advisor

District Court Invalidates Medicare GME Regulation and Orders CMS to Recalculate Hospitals’ Medicare Reimbursement

By Robert E. Wanerman

June 7, 2021

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Teaching hospitals should find that their Medicare reimbursement for training physicians will be a little sweeter thanks to a decision by the United States District Court for the District of Columbia. Milton S. Hershey Medical Center, et al. v. Becerra, No. 19-2680 (D.D.C. May 17, 2021). The hospitals challenged a 1997 regulation that set out a formula for counting the number of full-time residents and fellows. Under the Medicare statute, the government reimburses hospitals for…

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Podcast: Federal and State Cannabis Rules Are Moving in Different Directions – Diagnosing Health Care

By Epstein Becker Green

June 3, 2021

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In this episode of the Diagnosing Health Care Podcast: Federal and state cannabis regulation and enforcement appear to be moving in different directions. While the Food and Drug Administration (“FDA”) has broadened its net to target businesses making claims that their products can treat specific conditions, a growing number of states have passed bills that, among other things, legalize adult-use cannabis. Epstein Becker Green attorneys Delia Deschaine, Nathaniel Glasser, and Megan Robertson…

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Defendant Aventis Pharma Awarded Over $17.2 Million in Attorneys’ Fees in False Claims Act Case

By George B. Breen, Erica Sibley Bahnsen, Daniel C. Fundakowski, Elizabeth Harris & Devon Minnick

June 1, 2021

In a move that reminds us that successful defendants can—and should—seek attorneys’ fees in the right case, a magistrate judge in the U.S. Court of Appeals for the Ninth Circuit awarded pharmaceutical company Aventis Pharma SA (“Aventis”) attorneys’ fees in a False Claims Act (“FCA”) case brought by a competitor, Amphastar Pharmaceuticals Inc. (“Amphastar”). The FCA contains a fee-shifting component, permitting prevailing parties to recover attorneys’ fees from the opposing party—but the playing field is…

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OIG Issues Favorable Advisory Opinion on Ambulatory Surgery Center Joint Venture

By Ashley A. Creech

May 24, 2021

The U.S. Department of Health and Human Services’ Office of Inspector General (“OIG”) recently issued Advisory Opinion No. 21-02, regarding a joint investment by a health system, a manager, and certain surgeons in an ambulatory surgery center (“ASC”) (the “Proposed Arrangement”). According to a national survey, most hospitals and health systems are planning to increase their investments in ASCs and anticipate converting hospital outpatient departments to ASCs. Many hospitals with ASCs operate the…

Health Law Advisor

Thought Leaders on Laws and Regulations Affecting Health Care and Life Sciences

Blog Authors

DOJ’s Recent Telehealth Enforcement Action Highlights Increased Abuse of COVID-19 Waivers

Interoperability and Its Impact on Payors

Health Cos. Must Prepare For Growing Ransomware Threat

Information Blocking – How Did I Become an “Actor”?

Podcast: What’s New for Insurers in Mental Health Parity Compliance – Diagnosing Health Care

U.S. Department of Justice Announces Interagency Task Force to Combat COVID-19 Relief Fraud

District Court Invalidates Medicare GME Regulation and Orders CMS to Recalculate Hospitals’ Medicare Reimbursement

Podcast: Federal and State Cannabis Rules Are Moving in Different Directions – Diagnosing Health Care

Defendant Aventis Pharma Awarded Over $17.2 Million in Attorneys’ Fees in False Claims Act Case

OIG Issues Favorable Advisory Opinion on Ambulatory Surgery Center Joint Venture

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