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Showing 6 posts from November 2015.

On September 9, 2015, the U.S. District Court for the District of Columbia denied much of the Obama Administration's motion to dismiss the House of Representatives' Affordable Care Act (ACA) challenge in U.S. House of Representatives v. Burwell. The case claims that the Secretary of Health and Human Services (HHS) funded cost-sharing reduction (CSR) payments to insurance companies without the constitutionally required Congressional appropriation. The suit also included challenges to the Administration's delayed implementation of the employer mandate, but the court dismissed those claims. The Administration sought dismissal of the case, arguing that the House lacked standing and that the claims were not justiciable. The court has not yet addressed the merits of the House's claims. Read More ›

A final new regulation (the Final Rule) interpreting the federal self-referral restrictions imposed by the "Stark Law" was issued October 30, 2015, by the Centers for Medicare and Medicaid Services (CMS) makes a number of significant changes and provides important clarifications. The Stark Law prohibits physician referrals of Medicare patients for certain "designated health services" to entities with which the physician has a financial relationship unless an exception under the law applies to that relationship. Read More ›

As those in the health care industry are well aware, the federal False Claims Act (FCA) imposes stiff penalties for each false claim submitted to the federal government, resulting in recoveries of over $2 billion in fiscal year 2014 relating to federal healthcare programs alone. In recognition of the highly fact-dependent analysis and per-claim liability, plaintiffs must allege fraud with particularity in FCA actions. However, while the FCA continues to attach liability at a claim-by-claim level, some district courts have shown an increased willingness to endorse plaintiffs' controversial use of statistical sampling and extrapolation of such samples to establish liability in FCA actions involving a large number of alleged false claims. Read More ›

Several hospitals throughout California have been hit with putative class action lawsuits brought by counsel for uninsured patients alleging that the hospitals' charges for emergency services are unreasonably high and that the financial agreements signed by the patients requiring payment of charges are improper and not enforceable. The suits further allege that the hospitals' charges are unreasonably high and a surprise to patients. These cases are shaping up to be an important battleground over hospital chargemasters. Read More ›

In its search for savings to pay for increased defense and non-defense discretionary spending caps and to reduce a 50% increase in Part B premiums on some beneficiaries, Congress once again looked to Medicare payments to hospitals.  In addition to another extension of Medicare sequester, now through fiscal year 2025, Congress is establishing new policy to reduce reimbursement at certain off-campus hospital outpatient facilities.  Section 603 of the Bipartisan Budget Act of 2015 (BBA 2015), adds 42 U.S.C. § 1395l(t)(21) to the Medicare Act, and is projected to reduce payments by $9 billion over the ten-year budget window. Read More ›

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