Adam Appleberry

Subscribe to all posts by Adam Appleberry

DOJ and HHS Launch New False Claims Act Working Group to Target Healthcare Fraud

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

New CMS Model Targets Inefficient Medicare Spending Through AI and Clinical Oversight

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

DOJ Announces Largest Health Care Fraud Takedown in U.S. History

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 Legislature Passes Nation’s Strictest Restrictions on the Corporate Practice of Medicine

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

Oracle, Cleveland Clinic, and G42 Announce Strategic Partnership to Launch AI-Based Global Healthcare Delivery Platform

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

Virtual Healthcare Law Presentation: Understanding Restrictive Covenants and Key Contract Terms

On Thursday, May 22, from 6:00 – 7:00 PM, attorneys Michael Cassidy and Adam Appleberry will present a virtual program focused on the legal framework surrounding restrictive covenants in healthcare employment contracts. The presentation will cover recent developments in the law, including the Fair Contracting for Health Care Practitioners Act, and other regulatory changes that … Continue Reading

2025 Medicare Final Rule Highlights

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

Texas Judge Stops FTC Non-Compete Ban From Going Into Effect

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

Gov. Shapiro Signs Fair Contracting for Healthcare Practitioners Act Into Law

On July 17, 2024, Pennsylvania Governor Josh Shapiro signed the Fair Contracting for Health Care Practitioners Act into law, which will become effective as of January 1, 2025 (click here see the full bill). Any noncompete covenants that are greater than one year in length in an employment agreement for a healthcare provider, entered into … Continue Reading

UPMC/Washington Health System Merger Agreement Limits Non-Competes

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

Navigating HIPAA’s Breach Notification Rule Following A Breach

In light of the ongoing investigation of Change Healthcare’s ransomware attack that resulted in the improper disclosure of thousands of individuals’ PHI, now seems like a perfect time to discuss HIPAA’s requirements surrounding the notification process following a breach. Whether it’s a small breach where someone in your organization accidentally sent a patient’s contact information … Continue Reading

Businesses Challenge FTC’s Ban on Non-Compete Agreements

As expected, businesses have sued the FTC challenging the recent final rule that ends non-compete agreements, as reported by the Wall Street Journal Wednesday morning (read WSJ article here). The U.S. Chamber of Commerce challenged the final rule in federal court in East Texas, which has been joined by other business groups. A lawsuit was … Continue Reading

FTC Votes to Ban Non-Compete Agreements

In a Special Open Commission Meeting held this afternoon, the Federal Trade Commission voted to approve the final rule to ban non-compete agreements for for-profit businesses, the effective date of such ban being in 120-days. Important items of note with the final rule: The FTC acknowledged that much of the healthcare industry operates under a … Continue Reading

FTC To Rule on Banning Non-Compete Agreements

The Federal Trade Commission has announced that it will be holding a Special Open Commission Meeting on Tuesday, April 23, 2024, at 2pm EST regarding the rule to ban non-compete agreements (read the announcement here). The expectation for this meeting is that the FTC will disclose the proposed final rule followed by remarks by the … Continue Reading

HIPAA Fundamentals for Providers

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 to … Continue Reading

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 … Continue Reading

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, … Continue Reading
LexBlog