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Health
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May 17, 2013
Affiliation Dispute Threatens $2B St. Luke's Acquisition
A high-value affiliate of Houston-based St. Luke's Episcopal Hospital on Thursday asked a Texas court to nullify its collaboration agreement with the hospital, creating a possible hurdle to Catholic Health Initiatives' planned $2 billion deal to acquire the system.
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May 17, 2013
MLB Suit Over Performance Boosters Falls Flat, Clinic Says
A Florida health clinic asked a state judge Wednesday to toss a suit filed against it by Major League Baseball alleging it provided performance-enhancing drugs to Alex Rodriguez and other players, saying the league failed to properly state its claim and include all the necessary parties.
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May 17, 2013
Criminal Probes Await Top Health Cos.: Ex-DOJ Fraud Chief
The U.S. Department of Justice’s heavy focus on health care fraud in recent years is set to move into a new phase that will increasingly target major corporations and their executives with criminal investigations, said Sam S. Sheldon, a Quinn Emanuel Urquhart & Sullivan LLP partner who until recently headed up the DOJ's health care fraud unit.
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May 17, 2013
Hospitals' Medicaid Rate Suit Nixed By Texas High Court
The Texas Supreme Court on Friday rejected an argument by 14 hospitals that the state is required to recalculate Medicaid reimbursement rates for the 2002 through 2009 fiscal years, ruling that a 2008 decision the high court issued in the dispute afforded no such relief.
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May 17, 2013
Texas High Court Clarifies Profession Defamation Limits
The Texas Supreme Court ruled Friday that a doctor alleging he was defamed by another doctor who accused him of unprofessionalism and lying was not subjected to defamation per se because the statements had no bearing on his skills or competence as a physician.
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May 17, 2013
Obama Budget Would Save $153B In Health Spending: CBO
The president's budget proposal for the 2014 fiscal year would save the U.S. government $153.6 billion in health care spending over 10 years, the biggest chunk of which would come from applying Medicaid's prescription drug rebates to dual eligible beneficiaries, the Congressional Budget Office said Friday.
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May 17, 2013
Medicaid Fraud Units To Get Federal Funds For Data Mining
The Department of Health and Human Services' inspector general on Friday released a final rule that will allow Medicaid fraud control units to get federal funding to conduct data-mining activities, such as analyzing claims data to look for patterns of abuse, reversing a long-standing prohibition on such funds.
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May 17, 2013
Iowa Court Blocks Insurer Caps On Unreimbursed Dental Care
The Iowa Supreme Court on Friday ruled that insurers in the state can’t limit the maximum fee charged by a dentist for a service generally included in a dental plan but not reimbursed because of a plan restriction, overturning a decision by the state’s insurance commissioner.
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May 17, 2013
Hartford Sanctioned Again In Fight With Medical Center
Hartford Fire Insurance Co. was sanctioned Thursday for repeatedly misrepresenting to an Indiana federal court that it had turned over all of the documents that Illiana Surgery and Medical Center LLC requested in a coverage suit that arose after someone deleted valuable data from the hospital's computer system.
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May 17, 2013
GSK Says Comcast Ruling Kills Avandia Injury Class Action
GlaxoSmithKline PLC on Friday urged a Pennsylvania federal judge to reject two Humana Inc. units’ bid for class certification over costs borne by the insurers for treating Medicare patients harmed by the drug Avandia, contending that it is barred by the Supreme Court’s recent Comcast decision.
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May 17, 2013
Cardinal, Pharmacies Settle $3M Health Supply Contract Suit
Two pharmacies on Thursday agreed to a settlement with two Cardinal Health Inc. units, ending claims filed in Illinois federal court that they had breached the terms of their wholesale pharmaceutical purchase deals, costing Cardinal at least $2.7 million.
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May 17, 2013
Highmark Says Policyholders Can't Seek Antitrust Damages
Highmark Inc. on Friday again asked a Pennsylvania federal judge to toss an antitrust class action in which health insurance buyers accuse it of conspiring to stifle competition and inflate rates, arguing that the rates were approved by the Pennsylvania Insurance Department.
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May 17, 2013
Whistleblower Wants Jackson Lewis DQ'd In Sun FCA Suit
A whistleblower asked a Florida federal judge Thursday to disqualify Jackson Lewis LLP from representing Sun Healthcare Group Inc. in a suit accusing it of falsely billing Medicare, saying the firm has misused sealed records in another case.
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May 16, 2013
McKesson Beats Chem Rx Trustee's $10M Clawback Suit
A Delaware bankruptcy judge on Thursday tossed an adversary suit that sought to claw back nearly $10 million from McKesson Corp., finding nothing improper in payments made to the pharmaceutical product wholesaler by soon-to-be bankrupt pharmacy Chem Rx Corp.
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May 16, 2013
ACA’s Benefits For Hospitals Hinge On HHS Outreach
As the U.S. Department of Health and Human Services ramps up its efforts to educate the uninsured and enroll them in Medicaid and exchange health plans, experts say the success of the Affordable Care Act — and the ability of providers and insurers to reap the benefits they were promised — depends on just how successful HHS' outreach is.
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May 16, 2013
Fla. Supreme Court Upholds Birth Injury Compensation Plan
The Florida Supreme Court ruled Thursday that a state program providing set compensation to families of infants who sustain birth-related neurological injuries is constitutional, rejecting claims by an injured girl's parents that it violates equal protection and access to courts rights.
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May 16, 2013
GOP Bills Would Bar IRS From Implementing Health Law
Several Republican lawmakers introduced legislation this week aiming to prevent the Internal Revenue Service from implementing the Affordable Care Act, after the IRS admitted to targeting tea party and other conservative groups for audits.
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May 16, 2013
House Throws Fiscal Weight Behind VA-DOD Health Database
A House subcommittee on Wednesday considered a $73.3 billion bill to fund military construction and the Department of Veterans Affairs, approving provisions that would cut off information technology funding until the VA and U.S. Department of Defense agree on a joint health database for U.S. troops and veterans.
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May 16, 2013
House GOP Votes For Third Time To Repeal ACA
House Republicans on Thursday voted for the third time to scrap the Affordable Care Act in its entirety, a move that’s dead on arrival in the U.S. Senate and which underscores the relentlessness of conservative opposition more than three years after the law’s passage.
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May 16, 2013
VA Wants DaVita's Dialysis Underpayment Suit Trimmed
The U.S. Department of Veterans Affairs on Wednesday asked the U.S. Court of Federal Claims to trim thousands of payment claims from a DaVita Inc. suit accusing the agency of underpaying for dialysis services, arguing the claims were either time-barred or not allowed under law.
Expert Analysis
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Rise Of The Machines — Predictive Coding Goes Mainstream
The pros of using predictive coding far outweigh the cons. Given the heavy pressure on law firms and in-house counsel to reduce discovery costs, as well as the Justice Department's recent stance on the subject, it appears predictive coding will continue to emerge from the obscure world of legal technology to the mainstream of legal practice, say Michael Moscato and Myles Bartley of Curtis Mallet-Prevost Colt & Mosle LLP.
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PE Investors Should Consider Behavioral Health
As demand for behavioral health services increases, and those individuals with need have insurance that will pay for it, the growth potential for behavioral health services is significant. Private equity investors are well-poised for jumping into this market to bring new business models and innovation to the industry, say attorneys with McGuireWoods LLP.
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US V. MedQuest Is Important For Health Care FCA Cases
The Sixth Circuit recently reversed an $11.1 million False Claims Act judgment in U.S. v. MedQuest Associates. The court's refusal to impose the FCA’s “extraordinary penalties” on violations of technical and local Medicare program requirements represents significant precedent for health care providers facing an FCA suit, say attorneys with Ropes & Gray LLP.
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High Court's Nassar Case — What's At Stake For Employers
The U.S. Supreme Court recently heard argument for University of Texas Southwestern Medical Center v. Nassar, and while the case seems promising for employers, it should also remind them that their best protection against retaliation claims will continue to be contemporaneous written evidence of a real reason for taking unfavorable actions against an employee, say attorneys with Seyfarth Shaw LLP.
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Yet Another Cliff-Hanging OIG Report
In its ongoing series of studies and audits, the U.S. Department of Health and Human Services' Office of Inspector General recently released its report on Medicare hospice and general inpatient care. While the report clearly shows the OIG's concern for the substantial percentage of hospices not providing GIP, it also leaves several questions unanswered, say attorneys with Morgan Lewis & Bockius LLP.
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What Sponsors Must Know About Litigation On Church Plans
Recently, two firms have filed class actions against three Catholic Church-affiliated health care facilities, claiming that their pension plans should be subject to the Employee Retirement Income Security Act. These cases could have a profound effect on all church plan sponsors, regardless of whether they have previously obtained favorable church plan rulings, say attorneys with Drinker Biddle & Reath LLP.
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The Who, What And Why Of Public-Private Partnerships
Public-private partnerships have been used in a wide range of sectors to provide public services, from power plants and railroads to hospitals and sanitation plants. Yet there are a variety of potential contractual arrangements and the financing of a PPP can be complex, say Maryam Khosharay and Herbert Glaser of Haynes and Boone LLP.
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How To Physically Secure Electronic PHI
Increasingly sophisticated threats to information security, new regulatory requirements and ramped-up enforcement of the Health Insurance Portability and Accountability Act are prompting many health care providers and other covered entities to revisit their security policies. As these policies are revisited, physical security should undoubtedly be part of the conversation, say attorneys with Epstein Becker & Green PC.
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5 Questions To Consider When Forming An ACO
When forming an accountable care organization — a type of health care organization on the rise that aligns financial interests of providers while trying to decrease spending and increase the quality of care — health care providers should consider the five key questions, say attorneys with McGuireWoods LLP.
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E-Discovery In The Cloud: Who Can Get Your Data?
Many lawyers are asking whether placing electronically stored information in the cloud could inadvertently waive the attorney-client privilege and whether the government or a civil litigant could obtain ESI directly from a cloud service provider. In answering these questions, there are a number of aspects of the cloud worth considering, say Timothy Broas and Matthew Saxon of Winston & Strawn LLP.