On March 10, 2022, the Department of Justice (“DOJ”) appointed a Director for COVID-19 Fraud Enforcement.[1] As a part of this announcement, DOJ announced some of its priorities in Health Care Fraud enforcement. The priorities focus on kickbacks, utilizing the relaxed rules to bill for medically unnecessary or never performed services, vaccine-related fraud, and fraud …
Recent Guidance on Enforceability of Physician Non-Competes
As previously reported here, courts are known to “blue pencil” terms of non-compete provisions in employment agreements that do not appear to further legitimate business interests. Earlier this year, an Ohio appellate court affirmed the lower court’s modification of the scope and duration of a challenged non-compete provision found to be partially unreasonable. In Metrohealth …
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HOW APPLICATION PROGRAMMING INTERFACES APPLY TO HEALTHCARE ENTITIES
ONC Final Rule Information blocking On May 1, 2020, the Federal Department of Health and Human Services (“HHS”), Office of the National Coordinator for Health Information Technology (“ONC”) released a Final Rule (the “ONC Final Rule”), which implements the information blocking provision of the 21st Century Cures Act, enacted in 2016. The information blocking provision …
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Updates to Wit v. United Behavioral Health
The United States Court of Appeals for the Ninth Circuit recently released an unpublished memorandum decision in the landmark mental parity case of Wit v. United Behavioral Health. In this decision, the Ninth Circuit reversed the district court’s order requiring UBH to reprocess more than 60,000 claims that had initially been denied for not meeting …
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NEW EKRA INTERPRETATION PROVIDES SOME GUIDANCE IN ITS APPLICATION
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, …
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Telehealth Fraud Year in Review
The Department of Justice recently released their Year in Review summary of activity by the Healthcare Fraud Unit, detailing enforcements efforts related to some of the more significant telehealth-related fraud claims in 2021. The DOJ’s litigation unit significantly expanded last year to support the Fraud Unit, resulting in material criminal prosecutions and sentences. Since 2019, …
Court Strikes Down Portions of Federal Regulations Concerning No Surprises Act
Last month, we published an article summarizing new surprise billing laws that prohibit nonparticipating providers from balance billing patients when the patient’s insurance company pays less than the provider’s usual and customary charge. The Michigan law, known as the Surprise Medical Billing Law, has been in effect since last year. The Federal law, known as …
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Physician Non-Compete Agreements: What You Should Know
What are non-compete agreements? In the broadest sense, non-compete agreements prohibit an employee from accepting employment by a competitor of an employer for a certain time. They are treated differently than non-solicitation agreements and confidentiality agreements. While non-compete agreements may not solely prevent competition – the agreement cannot prohibit an employee from using general knowledge …
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Hot Topics in Behavioral Health in 2021
Erica Erman and Gregory Moore discussed some of the top developments in behavioral health during Dickinson Wright’s Health Law Summit. Below is a summary of what was discussed. Click here to view the full webinar. Table of Contents Development #1: New Trends in Parity Enforcement Recent Litigation, Including Wit v. United Behavioral Health Development #2: …
SURPRISE! NEW LAWS IMPACT PATIENT BILLING
Since last year, certain providers (e.g., anesthesiologists, radiologists, surgeons, etc.) in Michigan have had to navigate Michigan’s Surprise Medical Billing Law (“Michigan Act”). Starting January 1, 2022, those same providers have also had to comply with the Federal No Surprises Act (“Federal Act”). Generally, both statutes prevent nonparticipating providers from balance billing patients when the …
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