By Scott F. Roberts The advent of federally subsidized private pay health insurance under the Affordable Care Act has the potential to expand the application of the federal anti-kickback statute beyond just Medicare, Medicaid, and Tricare. The Affordable Care Act (sometimes referred to as “Obamacare”) currently allows individuals to purchase and receive private health insurance …
Legislation Permitting Healthcare Providers to Negotiate Jointly with Health Insurers Introduced in Congress
By James M. Burns Legislation was recently introduced by Representative John Conyers (D-Michigan) that would permit healthcare providers to negotiate jointly with health insurers concerning contract terms without running afoul of the antitrust laws. The bill, the “Quality Health Care Coalition Act of 2014,” (H.R. 4077), has been referred to the House Judiciary’s Subcommittee on …
The Academic Laboratory Exception
By Scott Roberts Part One: Determining Eligibility The federal Resource Conservation and Recovery Act, usually referred to as “RCRA”, governs the storage and disposal of hazardous waste, including hazardous medical waste. In addition to generally applicable regulations, RCRA provides a set of alternative rules, called the “Alternative Requirements for Hazardous Waste Determination and Accumulation of …
Windows XP Use May Violate HIPAA Starting April 8, 2014
By Rose Willis and Jared Smith If you use Windows XP on April 8, you will be easily susceptible to cyber-attacks and violations of the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”). Windows XP support is ending on April 8, 2014, when support and security updates will no longer be available. This means …
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FTC Commissioner Criticizes Proposed Legislation That Would Permit Health Providers to Negotiate Jointly with Health Insurers
By James M. Burns In a February 26 speech before the Connecticut Bar Association, Federal Trade Commissioner Maureen Olhausen expressed strong opposition to proposed legislation that would create an antitrust exemption for collective negotiations with health insurers by otherwise competing health care providers. Describing such proposals, which have been introduced at both the federal and …
The 2014 OIG Work Plan: Select Provisions Applicable to Physician Practices
By Rose J. Willis The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) recently issued its 2014 Work Plan outlining its intended review activities of HHS Programs for 2014. This article summarizes certain portions of the 2014 Work Plan that are of considerable importance to physician practices. Security of Protected …
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Hearing Held on Pennsylvania’s Novel “Any Willing Insurer” Legislation
By James M. Burns On December 18, 2013, the Pennsylvania House Health Committee held a hearing on Pennsylvania House Bills 1621 and 1622, two bills that would require that any health provider in the state that operates as part of an integrated delivery system (i.e., a health system that also has its own health plan, …
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CMS Issues Final Rule on Direct Access of Lab Test Results by Patients
By Rodney D. Butler On February 3, 2014, the Centers for Medicare and Medicaid Services (CMS) released a final rule that permits patients or their representatives to have direct access to the results of their lab tests. This rule change is significant because under the prior rule, labs could only release test results directly to …
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CMS Report Shows Some Medicare Cost Savings Through ACO Model
By Rodney D. Butler A report published last week by the U.S. Centers for Medicare and Medicaid Services (CMS) demonstrated, in the words of CMS, “encouraging results” in the reduction of healthcare costs to Medicare and improvement in the quality of care for over 5 million Medicare beneficiaries under the Affordable Care Act (ACA). Under …
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Mississippi Governor Rescinds Executive Order Requiring Blue Cross of Mississippi to Grant “In Network” Status to Excluded Hospitals
By James M. Burns In early November, Mississippi Governor Phil Bryant rescinded an Executive Order (Executive Order 1327), issued only weeks earlier, that would have compelled Blue Cross of Mississippi to continue to offer “in-network” status to several Mississippi hospitals with whom Blue Cross had terminated its relationship as a result of a contract dispute …