By Jessica L. Russell On June 9, 2015, the Department of Health and Human Services’ Office of the Inspector General (“OIG”) issued a new fraud alert regarding physician compensation arrangements, with a particular emphasis on medical director arrangements. The OIG urged physicians to “carefully consider the terms and conditions of medical directorships and other compensation …
Qui Tam Lawsuits and the Statute of Limitations
By Keith C. Dennen In Kellogg Brown & Root Services, Inc. v. United States ex rel. Carter, 575 U.S. ___) (2015), Justice Alito stated “[t]he False Claims Act’s qui tam provisions present many interpretive challenges.” Lawyers and judges who struggle with those challenges understand the truth of that statement. The United States Supreme Court recently …
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Responding to Subpoenas and Other Requests for Personal Health Information: Take Them at Face Value
By Billee Ward Healthcare providers and other HIPAA covered entities receive requests for protected health information (“PHI”) from a variety of sources on a daily basis. Such requests can range from informal requests made during the course of conversation with a patient or family member, to written requests or demands served by law enforcement personnel …
Iowa Supreme Court Affirms Ruling for Health Insurer in Antitrust Dispute
By James M. Burns In late February, the Iowa Supreme Court affirmed a lower court ruling in Mueller v. Wellmark, ending a seven year battle over whether the health insurer’s agreement with employers operating “self-funded” insurance plans to provide the same rate concessions obtained from providers by Wellmark to these plans constituted a per se …
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HHS Issues Proposed Rule for Stage 3 of EHR Incentive Program
By Jessica Russell On March 30, 2015, the Department of Health and Human Services (“HHS”) published its proposed rule for Stage 3 the Electronic Health Record Incentive Program (the “EHR Program”). The EHR Program is a three stage program that provides incentive payments to eligible professionals and eligible hospitals and critical access hospitals (“CAHs”) (collectively, …
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Legal and Regulatory Landscape for Mobile Health Technologies
By Brian Balow Mobile health (mHealth) technologies continue to expand in application and implementation. Over the past decade, the breadth of these technologies has grown from the creation of healthcare-directed websites (think WebMD) to implanted medical devices that constantly transmit and receive information (sometimes on a device-to-device basis). If you are either a provider or …
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Michigan Congressmen Introduce Bill Permitting Healthcare Providers to Negotiate Collectively with Health Insurers
By James M. Burns On January 6, two Michigan Congressmen – Representative John Conyers (D-Mich.) and Representative Dan Benishek (R-Mich.) – introduced the “Quality Health Care Coalition Act of 2015.” The bill (H.R. 105) would permit independent healthcare professionals to engage in joint negotiations with health insurers over fees and other contract terms. Currently, such …
Care Recipients’ Limited Right to Discriminate Based on Protected Characteristics of Care Provider
By David J. Houston Healthcare provider institutions including hospitals, clinics, medical practices, nursing homes and home health care providers (here, “Institutions”) are occasionally called upon to balance the preferences of Consumers against the interests or possible rights of their employee Care Providers. This may occur when Consumer complaints target assigned direct Care Providers – nurses, …
Will the ACO Proposed Rule Save the Shared Savings Program?
By Jessica L. Russell In 2011, CMS implemented the Accountable Care Organization (“ACO”) Shared Savings Program, which aims to promote increased savings for the Medicare program, improve health care quality, and create a more efficient and effective health care delivery system. While many deemed the ACO to be the future of health care models, the …
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PHIPA offers “no shelter” to Ontario Hospital from class proceedings for breach of privacy
By Wendy Hulton Back in 2012, the Ontario Court of Appeal recognized the tort of invasion of privacy – fast forward to the recent string of privacy breaches of personal information held by health care facilities in Ontario. Along comes Hopkins v Kay, 2014 ONSC 321 (CanLII), where patients from the Peterborough Regional Health Centre …