Legal and practical healthcare information.
On October 24, 2018, the Eliminating Kickbacks in Recovery Act (“EKRA”) was enacted. Broadly speaking, EKRA prohibits soliciting, receiving, paying, or offering “any remuneration (including any kickback, bribe, or rebate) directly or indirectly, overtly or covertly, in cash or in kind,” for referring or to induce a referral to a recovery home, clinical treatment facility, …
Continue reading “NEW EKRA INTERPRETATION PROVIDES SOME GUIDANCE IN ITS APPLICATION”
Those serving in the health care industry are all too familiar with the Anti-Kickback Statute and the Stark Law – physician self-referral and fraud and abuse laws that prohibit financial payments or incentives for referring patients, specifically a Medicare or Medicaid patient. In December 2020, The Officer of Inspector General (OIG) Final Rule and the …
Continue reading “Anti-Kickback Statute and Stark Law Recent Updates”
Many providers are familiar with compliance in a health care context. They know to make agreements compliant with the Stark Law and the Anti-Kickback Statute, for instance. But the keys to a good compliance system (policies and procedures, designation of a compliance officer/committee, training and education, communication, ethics and culture, top-down compliance, enforcement, auditing and …
Businesses at different levels in the supply chain of a product choose to merge (“vertical mergers,” compared with “horizontal mergers” where business at the same level in the supply chain merge) for a variety of reasons, many of which can be beneficial to competition and/or consumers. Vertical mergers can lead to efficiencies in supply chains, …
It is not uncommon for a physician organization to act as an intermediary between its physician participants and third-party payers to facilitate the negotiation and acceptance of reimbursement rates and other payer contract terms. However, when facilitation becomes negotiation and a PO accepts contracts with third-party payers on behalf of physician participants, also known as …
Continue reading “Is Your Physician Organization Complying with Antitrust Law?”
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 …
Continue reading “Iowa Supreme Court Affirms Ruling for Health Insurer in Antitrust Dispute”
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 …
Dickinson Wright Member James Burns recently spoke to Bloomberg BNA’s Pharmaceutical Law & Industry Report for the article, “Biosimilars Policy, Accelerating Medical Breakthroughs Among Year’s Key Topics” (1/16/2015). In the article, Mr. Burns discusses some of the key antitrust issues for the upcoming year in the pharmaceutical industry. Mr. Burns noted that one significant issue …
By James M. Burns and Jessica Russell On October 1, a first-of-its-kind law became effective in Connecticut that requires group medical practices and hospitals in that state to provide the Attorney General with 30 days’ notice prior to consummating any merger or affiliation-type transaction. The new law (P.A. 14-168) is noteworthy because the threshold for …
Continue reading “Connecticut Law Imposes New Merger Regulations on Physician Combinations”
By Rose Willis The United States Office of Inspector General (“OIG”) recently issued a “Special Fraud Alert” focusing on two potentially illegal trends that it has detected in arrangements between laboratories and their referring physicians. This post focuses on the first trend (Specimen Processing Arrangements); the second trend (Registry Payments) will be the subject of …