Did the FCA’s “Implied Certification” Theory Dodge a Bullet?

Yesterday’s argument before the Supreme Court in Universal Health Services, Inc. v. U.S. ex rel. Escobar had the potential to put false claims based on an “implied certification” in the crosshairs. Instead, based on the weight of questioning by a plurality of justices, it appears that some form of implied certification theory may survive. (We previously reported on this case, here.) Continue Reading

Be Alert: Ransomware Attacks on the Rise

Big name companies, government agencies and individuals are all falling victim to “ransomware” attacks in record and still-rising numbers. Recently, Hollywood Presbyterian Hospital’s communications capabilities were disabled for 10 days before the hospital paid a ransom of 40 bitcoins – about $17,000 – and regained access to its system. And this week Medstar Health, a system of ten major hospitals in the Washington, DC area, reportedly suffered a similar attack. All this activity has led experts to label 2016 as “the year of ransomware.”  And this new form of cyberattack requires a different approach to cybersecurity and incident recovery than your data breach prevention plan. Continue Reading

CMS Grants Extension to Apply for 2015 Meaningful Use Hardship Exemption

The Centers for Medicare and Medicaid Services (“CMS”) continues to work to ensure it is responsive to providers who tried to meet meaningful use standards in 2015 but faced hardships in their efforts. Eligible professionals, eligible hospitals & critical access hospitals (“CAH”) now have until July 1, 2016 to apply to CMS for the Medicare EHR Incentive Program hardship exception under the new, streamlined process under the Patient Access and Medicare Protection Act (“PAMPA”), signed by the President in December 2015. CMS indicates on its website that the extension is to ensure “providers have sufficient time to submit their applications to avoid the 2017 payment adjustment.”  Eligible providers who did not meet meaningful use standards for 2015 receive an adjustment to their 2017 payment unless CMS grants a hardship exception. Continue Reading

CMS Clarifies 60 Day Overpayment Rule

The Department of Health and Human Services’ (HHS) Center for Medicare and Medicaid Services (CMS), is set to publish a final rule that will provide some much needed relief to healthcare providers from the burdens of the so-called 60-Day Overpayment Rule.  The final rule clarifies (1) the 60 day period for refunding overpayments is not triggered until both the fact and amount of an overpayment are known; (2) the standard for knowledge is not “actual knowledge,” but when the provider would have identified the overpayment had it exercised reasonable diligence; and (3) the manner in which the refund must be made. Continue Reading

Initiative to Improve Quality After Discharge: New Caregivers’ Laws

This month Indiana,[i] Illinois,[ii]  California,[iii] Oregon,[iv] and New Hampshire[v] join  11 other states with newly effective  Care Advise Record Enable (CARE) laws[vi] requiring hospitals to give patients the opportunity to designate caregivers to assist them after leaving the hospital.  These laws are in  response to an initiative from the American Association of Retired Persons (AARP) to enable patients to have coordinated assistance with care after discharge.  Continue Reading

Day One Notes – JP Morgan Healthcare Conference, San Francisco

Someone asked me last week what it was like to attend the JP Morgan Healthcare Conference in San Francisco, which started its annual run today. Outside the conference hotel right now is the obligatory lunchtime sidewalk protest with chants of “Personal Health, Not Corporate Wealth,” while inside healthcare industry investors and operators together are chanting “pop health” instead.  The conference again is well attended, with a broad representation of for-profit and non-profit companies from the health services, health information technology and life sciences sectors.  In a sense, it’s the old-style Times Square of the healthcare industry – stand in one spot at the conference long enough and you’ll see almost every major organization walk by. Continue Reading

Federal Spotlight Continues to Shine on Physician-Owned Distributorships

A recent Senate Finance Committee hearing investigated the effects of physician-owned distributorships (“PODs”) on costs of care and patient safety, suggesting that the momentum for greater oversight of such business arrangements continues to build.[1]

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