Triage Health Law

Latest from Triage Health Law

Proposed Changes to the Anti-Kickback Statute, Stark Law and Civil Monetary Penalties Law Address Value-Based Healthcare Environment

By Robert Nauman on October 18, 2019

On October 9, the Department of Health and Human Services (HHS) released proposed rules (the Proposed Rules) aiming to update the Anti-Kickback Statute (the AKS), Stark Law and Civil Monetary Penalties Law (CMPL) to address today’s value-based and coordinated healthcare environment. The proposals reflect a recognition on HHS’s part that the healthcare landscape of today is significantly different from when these laws were adopted. Overall, HHS’s Proposed Rules appear directed at ensuring that the AKS,…

Triage Health Law

Court Sides with Hospitals on CMS Site Neutral Payment Rule for Hospital Outpatient Departments

By John Wyand & Callan Smith on October 1, 2019

In a ruling on September 17, 2019 by Judge Rosemary M. Collyer, the U.S. District Court for the District of Columbia vacated portions of a 2018 Centers for Medicare & Medicaid Services (CMS) rule that reduced Medicare payments for clinic-visit services at off-campus hospital outpatient departments (HOPDs). By rulemaking, on January 1, 2019, CMS instituted a “site neutral” payment policy by equalizing Medicare Part B payment rates under both the Outpatient Prospective Payment System (OPPS)…

Triage Health Law

Kentucky Appellate Court Affirms Dismissal of Enrollee Claims Against MCOs

By Jeffrey DeBeer on September 26, 2019

The Kentucky Court of Appeals recently affirmed dismissal of numerous lawsuits filed by Medicaid enrollees against Managed Care Organizations (“MCOs”) and the Commonwealth’s Cabinet for Health and Family Services (the “Cabinet”). Appalachian Reg’l Healthcare, Inc. v. Commonwealth, No. 2015-CA-001670-MR, 2019 Ky. App. Unpub. LEXIS 629 (Ct. App. Aug. 30, 2019). Applying recent Kentucky Supreme Court authority, the Appellate Court ruled that the enrollees lacked constitutional standing to sue. Id. (citing Cabinet for Health & Family…

Triage Health Law

Is it Legal to Maximize Value of Secondary Diagnosis Codes?

By Thomas Zeno on September 4, 2019

By selecting a more severe Secondary Diagnosis Code for a patient, a physician may increase the reimbursement due from Medicare. If a hospital intentionally changes codes across its patient population, the increased revenue can be substantial. Is that legal? A federal district court in Texas faced this question when a relator filed suit under the False Claims Act.…

Triage Health Law

DOJ Gloves Off in Opioid Fight

By Marisa Darden on July 24, 2019

In 2019 the Department of Justice took off its gloves in the opioid fight. For the second time, DOJ has acted to hold opioid distributors and manufacturers criminally liable for contributing to the drug crisis. Read my analysis here in the Anticorruption blog.…

Triage Health Law

HHS Abandons Proposal to Reform Drug Manufacturer Rebate System

By Kinal Patel on July 17, 2019

On Thursday, July 11, 2019, the White House administration reversed course on the Department of Health and Human Services’ (HHS) recent proposal to reform drug manufacturer rebate system. As we previously reported, HHS’s February 6, 2019 proposed rule sought to modify the Anti-Kickback Statute safe harbor protection with the aim of lowering prescription pharmaceutical product prices and out-of-pocket costs for consumers (primarily Medicare Part D and Medicaid Managed Care Plan members). With the proposed…

Triage Health Law

DOJ Challenges Charitable Copay Subsidies

By Thomas Zeno on July 16, 2019

The Department of Justice intervened in a False Claims Act lawsuit involving “so-called charitable patient assistance funds” used for prescription drug copays. The DOJ wants to make “clear that the Department will hold accountable drug companies that pay illegal kickbacks to facilitate increased drug prices.” See a report at the Anticorruption blog here.…

Triage Health Law

Healthcare Employers: Exercise Caution When Enforcing Mandatory Vaccination Policies

By Dylan J. Yépez on July 5, 2019

Healthcare employers should consider a recent trend when determining what safety requirements to impose on their employees. Recent settlements between healthcare providers and the Equal Employment Opportunity Commission show that even employers in the healthcare industry must consider accommodating their employees’ religious beliefs when enforcing mandatory vaccination policies. On June 25, 2019, the EEOC announced that a Michigan hospital had agreed to compensate a medical transcriptionist $74,418 to settle claims arising from the hospital’s alleged…

Triage Health Law

Three weeks to go until Oral Arguments in Texas v. United States

By David Archer on June 17, 2019

There are now only three weeks before the Fifth Circuit Court of Appeals is scheduled to hear oral arguments in Texas v. United States, the latest legal front in the ongoing battle over the future of the Patient Protection and Affordable Care Act (ACA). Texas v. United States is a lawsuit focusing on the indispensability of the individual mandate, which required most Americans to maintain “minimum essential” health insurance coverage, to the rest of the…

Triage Health Law

DOJ Pursues False Claims for EHR incentives

By Thomas Zeno on June 13, 2019

The Department of Justice ramps up enforcement against providers who claim incentives under the Electronic Health Records initiative. Read an update here on our Anticorruption blog.…

Triage Health Law

Blog Authors

Proposed Changes to the Anti-Kickback Statute, Stark Law and Civil Monetary Penalties Law Address Value-Based Healthcare Environment

Court Sides with Hospitals on CMS Site Neutral Payment Rule for Hospital Outpatient Departments

Kentucky Appellate Court Affirms Dismissal of Enrollee Claims Against MCOs

Is it Legal to Maximize Value of Secondary Diagnosis Codes?

DOJ Gloves Off in Opioid Fight

HHS Abandons Proposal to Reform Drug Manufacturer Rebate System

DOJ Challenges Charitable Copay Subsidies

Healthcare Employers: Exercise Caution When Enforcing Mandatory Vaccination Policies

Three weeks to go until Oral Arguments in Texas v. United States

DOJ Pursues False Claims for EHR incentives

Company

Support

New to the Network