In March of this year, The Office for Civil Rights of the Department of Health and Human Services issued a letter addressing the recent cybersecurity incident impacting many health care entities, primarily Change Healthcare, a unit of UnitedHealthcare Group (read the letter here). This incident was a great reminder of the constant vigilance required
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Medicare Conversion Factor Increased to $33.2875
The 2024 Consolidated Appropriations Act passed and signed on Saturday, March 23, 2024, increased of Medicare Conversion Factor from $32.7442 to $33.2875, an increase of slightly over $0.54.
U.S. Department of Justice (DOJ) Provides Corporate Fraud Enforcement Update
During the American Bar Association’s 39th National Institute on White Collar Crime, the most senior executives of the DOJ (Attorney General Merrick B. Garland and Deputy Attorney General Lisa Monaco) delivered remarks promoting the success of DOJ compliance and enforcement by:
- Emphasizing the DOJ’s top priority being the prosecution of “corner office bad actors”
- Publicizing
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Change Healthcare Cyberattack Disrupts Physician Payments
“On February 21, 2024, Change Healthcare, a subsidiary of UnitedHealth Group was the victim of the most significant cyberattack on the US healthcare system in American history. Change Healthcare is the predominant source of more than 100 critical functions that keep the healthcare system operating.”
–American Hospital Association Letter March 4, 2024
This hack…
Penn State Health Agrees To Pay Over $11 Million Due To Violations Of Medicare Rules & Regulations
Penn State Health has agreed to pay $11,712,336 to settle allegations of civil liability from submitting improper claims to Medicare for Annual Wellness Visit services.
DOJ Press Release Link
Penn State Health has voluntarily disclosed that between December 2015 and November 2022 claims were submitted to Medicare for Annual Wellness Visit services that were not…
HHS Healthcare Sector Cybersecurity
In furtherance of the National Cybersecurity Strategy announced March 2023, HHS has released an Introduction to the Strategy of the U.S. Department of Health and Human Services for Healthcare Sector Cybersecurity. Click here for the PDF.
False Claims Act (FCA) Liability for Physician Compensation Exceeding Fair Market Value (FMV)
When negotiating physician compensation issues, hospitals frequently rely upon the premise they must pay fair market value compensation in order to comply with the provisions of the Stark Act prohibiting referrals in exchange for compensation, and sometimes non-profit inurement issues.
Although the prohibitions are clear, determining what constitutes fair market value is often not. Provisions…
Biden Administration to Appeal Surprise Billing Defeat
As reported earlier in the MedLaw Blog (August 9, 2023), a federal District Court vacated portions of the No Surprises Act federal regulations. Thereafter, CMS halted the arbitration process for resolving disputes regarding out-of-network surprise bills.
On October 20, 2023, HHS, Treasury, and the US Office Personnel Management submitted a notice indicating their…
FTC Sues Anesthesiology Provider and PE Firm Over Anticompetitive “Roll Up” Scheme
As Mike Cassidy and Adam Appleberry discussed during their presentation at PBI’s A Day in Health Law earlier this month, private equity’s involvement in healthcare will be an interesting item to watch over the next few years. Just last week, the FTC sued the U.S. Anesthesia Partners, Inc. and their private equity backer Welsh, Carson,…
Allegheny County Medical Society Bulleting Article on Contracting Essentials for all Physicians, Especially Residents and Fellows
Michael A. Cassidy and Adam J. Appleberry co-wrote an article titled “Contracting Essentials for All Physicians, Especially Residents and Fellows”. This article will appear in the Legal Summary section of the August 2023 Allegheny County Medical Society (ACMS) Bulletin. The ACMS Bulletin is the Allegheny County Medical Society’s signature publication which reaches over 2,000 physicians…