Seth Goldberg
Earlier this month, the Antitrust Division of the DOJ, the Department of Health and Human Services, and the Federal Trade Commission announced a joint cross-government inquiry into the control over health care by private equity firms and other corporate owners, and, in conjunction with that announcement, released a Request for Information seeking public
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Healthcare False Claims Act Judgments/Settlements Lead Way in 2023
Federal and State Antitrust Enforcers Reiterate Focus on Healthcare
Federal and state antitrust enforcers are keenly focused on potential anticompetitive conduct in the healthcare space.
Federal Trade Commission Chair Lina Kahn recently noted that “the FTC is squarely focused on tackling illegal business practices that deprive Americans of access to affordable and innovative healthcare” in a speech to the American Medical Association’s national advocacy…
EMR Software Utilizing AI Targeted for Fraud and Abuse
Seth Goldberg
Artificial intelligence (AI) can enhance efficiencies in providing healthcare in many ways, one of which is by utilizing algorithms to read medical records and thereby assist providers in better understanding their patients and treatments that may be available. Increasingly, electronic medical review (EMR) software companies are utilizing AI to boost their products, offering…
CMS Rules for Coding Emergency Department Claims
By Gregory A. Brodek and Arti Fotedar
The Centers for Medicare and Medicaid Services (CMS) has consistently authorized hospitals to establish and utilize their own coding guidelines for emergency department facility claims. CMS makes clear that “[a]s long as the services furnished are documented and medically necessary and the facility is following its own system,…
FTC Wields Health Breach Notification Rule for First Time in Quest to Protect Consumer Health Information
By Samantha Dalmass and Melissa Sobel Snyder
The Federal Trade Commission (“FTC”) is seeking enforcement under the Health Breach Notification Rule for the first time since the rule was adopted in 2009. The Health Breach Notification Rule (16 C.F.R. Part 318) requires vendors of personal health records, PHR-related entities, and third party service…
340B Hospital Reimbursement Update: D.C. District Court Remands Underpayment Remedy to HHS
On Tuesday, January 10, 2023, the United States District Court for the District of Columbia issued an important ruling allowing the U.S. Department of Health and Human Services (HHS) to propose an appropriate retrospective remedy for underpayments made from 2018 through September 27, 2022, to hospitals participating in the 340B drug pricing program.
To read…
Revised Code of Pharmaceutical Research and Manufacturers of America Takes Effect
On January 1, 2022, the updated Code on Interactions with Health Care Professionals, published by the Pharmaceutical Research and Manufacturers of America (PhRMA), became effective. The updates reflect fraud and abuse concerns voiced by the Department of Health and Human Services’ Office of Inspector General in its November 2020 Special Fraud Alert. While it is…
CMS Mandate Blocked Nationwide
By Erin M. Duffy and Samantha Dalmass
A federal judge in New Orleans blocked the Interim Final Rule with Comment requiring the vaccination of all staff of health care facilities subject to the health and safety standards under the Medicare Conditions of Participation (“CoPs”) issued by the Centers for Medicare and Medicaid Services (“CMS”) earlier…
New Reporting Requirements for Philadelphia Health Care Facilities
By Erin M. Duffy and Samantha Dalmass
On June 9, 2021 Mayor Jim Kenney signed municipal legislation amending the Philadelphia Health Code to add a section establishing reporting and employment requirements related to changes in ownership or of the license holder of long-term care facilities and hospitals. Proposed in April by the Committee on Public…