The U.S. Department of Health and Human Services (HHS) and the Department of Justice (DOJ) have jointly announced the launch of a reinvigorated DOJ-HHS False Claims Act Working Group aimed at enhancing interagency coordination around key fraud enforcement priorities in the healthcare space. This initiative underscores the federal government’s ongoing reliance on the False Claims … Continue Reading
The Centers for Medicare & Medicaid Services (CMS) has launched the WISeR Model (Wasteful and Inappropriate Service Reduction) to modernize and streamline Medicare’s prior authorization process. By partnering with tech companies, CMS will test the use of modern tools, such as artificial intelligence, to reduce unnecessary or low-value services that drive up costs and pose … Continue Reading
In the largest health care fraud takedown in U.S. history, the Justice Department announced charges against 324 individuals—including 96 licensed medical professionals—in connection with schemes involving over $14.6 billion in intended losses across 50 federal districts and 12 State Attorneys General Offices. The coordinated enforcement action led to the seizure of more than $245 million … Continue Reading
Oregon is on the verge of passing a bill that would block private-equity ownership in healthcare practices. If passed, this measure would be the strictest ban on the corporate practice of medicine in the nation (read press release here). The bill would prohibit Management Services Organizations (MSOs) and their affiliates from owning or controlling shares … Continue Reading
In attempt to deliver more effective and affordable care, Oracle, Cleveland Clinic, and G42 have announced a strategic partnership that will build a global AI-powered healthcare platform (see news release here). Per the news release published by Cleveland Clinic, the platform will: (i) deliver an AI-driven healthcare infrastructure rooted in data privacy, clinical quality, and … Continue Reading
Attorneys Mike Cassidy and Adam Appleberry co-authored an insightful article, 2025 Medicare Final Rule Highlights, featured in the December 2024 issue of the Allegheny County Medical Society (ACMS) Bulletin. The article explores the key updates to Medicare regulations and their implications for healthcare providers. Click here to access the ACMS Bulletin to read the full … Continue Reading
This is a last in a series of client alerts and blog posts we’ve issued over the last year designed to inform you of the new Federal and Pennsylvania corporate reporting obligations. ALERT: The U.S. District Court E.D. Texas has issued a nationwide preliminary injunction against enforcement of the reporting rules below. Federal The financial … Continue Reading
In a continuation of the saga surrounding the FTC’s ban on non-compete agreements for for-profit businesses, on August 20, 2024, a ruling from the United States District Court for the Northern District of Texas struck down the FTC’s final rule. In the Texas court’s ruling, U.S. District Judge Ada Brown stated that the FTC’s authority … Continue Reading
The Press has announced that the Merger Agreement between UPMC and Washington Health System was approved by the Pennsylvania Attorney General with certain conditions, one of which was that UPMC would honor existing employment contracts and not impose restrictive covenants or non-compete agreements more restrictive than those that currently exist. We will be researching that … Continue Reading
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: Here are links to the remarks of Attorney General Garland and Deputy Attorney General … Continue Reading
“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 was … Continue Reading
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 … Continue Reading
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.… Continue Reading
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 … Continue Reading
CMS issued the Final Rule for the 2024 Medicare Physician Fee Schedule (PFS) on November 2, 2023, for payments to be effective on or after January 1, 2024. Fee Schedule Link The overall payment rates under the PFS will be reduced by 1.25% in calendar year 2024. The final PFS conversion factor will be $32.74, … Continue Reading
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 attempt to … Continue Reading
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, … Continue Reading
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 in Southwestern Pennsylvania … Continue Reading
Michael Cassidy has been recognized again in the 30th edition of the Best Lawyers in America for his “exceptional work in healthcare law”. … Continue Reading
CMS has halted the arbitration process for “Surprise Billing” established by the “No Surprises Act” for the second time, stating as follows: UNPLANNED OUTAGE “On August 3, 2023, the U.S. District Court for the Eastern District of Texas issued a judgment and order in Texas Medical Association, et al. v. United States Department of Health … Continue Reading
The 2024 Medicare Physician Fee Schedule proposes a 3.34% decrease in the 2024 PFS conversion factor. It’s currently $33.89 and is proposed to be reduced to $32.75. CMS is also proposing the following: Attached is the Fact Sheet released by CMS on July 13, 2023.… Continue Reading
Since the private equity issue was last addressed in the Bulletin in the Summer of 2022, the volume of healthcare private equity deals has subsided somewhat, according to statistics presented at the March 2023 Pennsylvania Bar Institute Health Law Conference, and that has generally been attributed to unfavorable market conditions affecting investments of all types. … Continue Reading
On January 5, 2023, the Federal Trade Commission (FTC) took a dramatic step by proposing a new rule that would prohibit companies from entering into non-compete agreements with its workers. The proposed rule, if approved, takes sweeping action to prohibit employers from entering into non-compete agreements with both employees and independent contractors. And the proposed … Continue Reading
The final “2023 Omnibus Bill” which is the spending bill passed by Congress and signed by President Biden at the end of 2022, provides partial relief from the scheduled Medicare Physician Fee Schedule Conversion Factor cuts. As previously reported, the changes to the Medicare Physician Schedule Conversion Factor would have reduced physician reimbursement by 4.5%. … Continue Reading
On January 5, 2023, the Federal Trade Commission (FTC) took a dramatic step by proposing a new rule that would prohibit companies from entering into non-compete agreements with its workers. The proposed rule, if approved, takes sweeping action to prohibit employers from entering into non-compete agreements with both employees and independent contractors. And the proposed … Continue Reading
