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May 16, 2012
HHS Outlines Benchmarks For State Health Exchanges
The U.S. Department of Health and Human Services on Wednesday unveiled a blueprint outlining how states can build health care exchanges where consumers can comparison shop for medical coverage.
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May 16, 2012
Specialty Products' Asbestos Creditors Float Ch. 11 Plan
Creditors with claims for asbestos-related health problems proposed the initial reorganization plan for Specialty Products Holdings Corp. on Monday, hoping to jump-start a case stalled by the difficulty of estimating the bankrupt company’s massive asbestos liability.
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May 16, 2012
Senate Advances Bill On Same-Sex Benefits For Govt. Workers
On the heels of President Barack Obama’s endorsement of same-sex marriage, a Senate committee Wednesday advanced bipartisan legislation that would grant additional health benefits to domestic partners of federal employees.
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May 16, 2012
Bishops Threaten Suit Over Contraception Coverage Rule
Catholic leaders on Tuesday renewed their call for the Obama administration to scrap a rule requiring employers to include free contraceptive care in their health plans they claim is unconstitutional, and threatened to sue the government to block its implementation.
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May 16, 2012
Q&A With Sills Cummis' Gary Herschman
Regulators and prosecutors have become more aggressive in pursuing health care facilities for refunds and penalties based on allegedly "improper" billings or failure to comply with comprehensive, and to some extent ambiguous, regulatory frameworks. If these investigations continue to increase, health care providers that are an integral part of the community will eventually reduce services or cease operations, says Gary Herschman, chairman of Sills Cummis & Gross PC's health care practice group.
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May 15, 2012
Ex-Partner Says Troutman Shafted Him Over $20M MetCap Fee
A former Troutman Sanders LLP partner accused the firm Monday of improperly releasing his signature to allow a merger agreement amendment depriving boutique investment bank MetCap Securities LLC of a $20 million fee for advising on a $2 billion acquisition of a nursing home operator.
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May 15, 2012
Suit Over DLA Piper Fees Will Stay In Bankruptcy Court
An Indiana federal judge on Tuesday refused to take on a case from bankruptcy court seeking to claw back $1.3 million in fees that DLA Piper LLP earned advising on a 2006 leveraged buyout that allegedly left Heartland Memorial Hospital LLC insolvent.
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May 15, 2012
ProMedica Knew Of FTC Merger Probe, Insurer Tells 6th Circ.
A unit of OneBeacon Insurance Group Ltd. told the Sixth Circuit on Monday that it wasn't obligated to cover defense costs in antitrust litigation challenging a merger involving ProMedica Health System Inc. because ProMedica failed to report the potential claim on time.
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May 15, 2012
Texas Docs Want HHS To Drop New Coding System
The Texas Medical Association on Friday urged the U.S. Department of Health and Human Services to abandon its proposed rule requiring health care providers to switch their billing systems to the updated ICD-10 coding system, a month after the agency said it would delay the switch.
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May 15, 2012
Accretive Taps Daschle, Frist To Pen Patient-Billing Rules
Illinois-based Accretive Health Inc., under fire for allegedly unscrupulous billing practices, on Tuesday announced it is paying two former senators and other big-name players to help develop national standards on how hospitals and patients interact when discussing the cost of treatment.
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May 15, 2012
Temple Settles With Feds Over Bogus Health Billing Allegations
Temple University in Philadelphia will pay more than $400,000 to settle allegations of health care fraud involving a convicted eye doctor and plastic surgeons on the campus payroll, federal prosecutors said Tuesday.
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May 15, 2012
King & Spalding Nabs Health Care Duo From Baker Donelson
The Washington health care practice at King & Spalding LLP is fitter than ever after luring two ex-Baker Donelson Bearman Caldwell & Berkowitz PC attorneys known for energetically navigating the maze of federal medical industry regulation, the firm announced Monday.
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May 15, 2012
UPMC Says West Penn Merger Warrants Stay Of Antitrust Suit
The University of Pittsburgh Medical Center on Monday asked a Pennsylvania federal judge to stay an antitrust suit brought by West Penn Allegheny Health System due to a pending $475 million acquisition of West Penn by insurer Highmark Inc.
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May 15, 2012
Chinese Drywall Developer Makes $5M Deal With Homeowners
A Florida real estate developer on Monday agreed to pay $4.8 million to a class of condominium owners who claim that Chinese-manufactured drywall used in the construction of the homes caused health problems and property damage.
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May 15, 2012
UnitedHealth Seeks 3rd Circ. Win Over Coverage Denials
UnitedHealth Group Inc., the nation’s second-largest health insurer, asked the Third Circuit on Friday to uphold dismissal of a proposed class action challenging the company’s refusal to reimburse care provided under employee retirement plans.
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May 15, 2012
Q&A With Akin Gump's Stephanie Webster
The system needs to be improved so that contentious Medicare payment issues are fully addressed through agency rulemaking before they produce litigation and so that any ensuing litigation moves through the administrative process at more than a snail's pace, says Stephanie Webster, a partner with Akin Gump Strauss Hauer & Feld LLP and former attorney with the U.S. Department of Health and Human Services.
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May 15, 2012
Cardinal Agrees To Shipping Ban Over Oxycodone Orders
Cardinal Health Inc. has accepted a two-year ban on shipping prescription drugs from its Florida distribution center to settle allegations that it filled suspicious orders for oxycodone, ending a legal battle with the U.S. Drug Enforcement Administration, the parties said Tuesday.
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May 14, 2012
9th Circ. Says 'Knowing' Access Enough For HIPAA Breach
The Ninth Circuit on Thursday rejected a former doctor’s argument that he did not know it was illegal when he accessed private health information of co-workers and celebrities, finding that knowingly obtaining such information is enough to violate the Health Insurance Portability and Accountability Act.
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May 14, 2012
Blue Cross Hit With Market Allocation Suit In Tenn.
Blue Cross Blue Shield of Tennessee was hit Thursday with an antitrust class action by a customer claiming the health insurance giant conspired with other BCBS plans nationwide to divide geographic markets, creating a monopoly that illegally inflated premiums for thousands of policyholders.
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May 14, 2012
High Court Won't Hear CUNA Retirees' Health Benefit Appeal
The U.S. Supreme Court said Monday it would not review the Seventh Circuit's holding that CUNA Mutual Insurance Society had been within its rights when it terminated payments toward health costs for a proposed class of retirees.
Expert Analysis
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When HIPAA Is Not Enough: Tougher Texas Privacy Laws
New privacy requirements that are more stringent than the Health Insurance Portability and Accountability Act have entered into force in Texas. These changes are likely to have significant reach, impacting not only HIPAA-covered entities, but also governmental entities, schools and universities, and other entities in Texas that process protected health information, say attorneys with Goodwin Procter LLP.
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Document Review Considerations
An e-discovery review usually requires significant manpower and a certain level of expertise to be done properly, and many in-house legal departments turn to litigation support and discovery management providers as an alternative for first-pass document review. Regardless of who performs it, proper preparation and planning in advance of a review is the key to its success, says Stacy Jackson of IE Discovery.
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Where Rubber Hits Road: Examples Of Alternative Fees
Creating new approaches to fee agreements is something to embrace rather than fear — and when structured and managed correctly, it can be financially advantageous. Take, for example, fixed-fee arrangements, result-based billing and portfolio billing, say Bill Rudnick and Keith Maziarek of DLA Piper.
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FCA Cases May Be Lurking Within CMS Refund Obligation
The U.S. Center for Medicare and Medicaid Services has published a proposed rule implementing a section of the Patient Protection and Accountable Care Act that requires providers to report and repay Medicare and Medicaid overpayments within a set period. As-is, the CMS proposal leaves open a maze of questions that affect False Claims Act liability, say Robert Hauberg and Jonell Beeler of Baker Donelson Bearman Caldwell & Berkowitz PC.
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Helpful Health Care Guidance From Iowa Supreme Court
The Iowa Supreme Court recently issued two opinions that advance our understanding of important concepts, including a public hospital’s obligation to release internal audit reports pursuant to open records requests, and the standard of care applicable to a hospital board of directors in fulfilling its credentialing function, say William Miller and Alissa Smith of Dorsey & Whitney LLP.
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The Costs Of A Potential Blue Cross Conspiracy
Two recent lawsuits allege that Blue Cross and Blue Shield Association entities in North Carolina and Alabama have violated federal and state antitrust laws by engaging in concerted action with other BCBS plans nationwide. If the plaintiffs’ allegations of market allocation are true, the cases may have significant implications for providers, say attorneys with King & Spalding LLP.
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DEA Checkup — Controlled Substance Prescriptions
Physicians are constantly warned about being on the lookout for prescription abuse. Unfortunately, this isn’t just a medical diagnosis issue. Physicians are facing increased scrutiny from state licensing and prosecutorial agencies and federal payors. Now an even bigger and less understanding player is entering the field — the Drug Enforcement Administration, says Dennis Lee of Fenton Nelson LLP.
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Plan Audits Mark The Start Of DOL Enforcement Of PPACA
In audit requests to health and welfare plans, the U.S. Department of Labor has made inquiries related to various mandates under the Patient Protection and Affordable Care Act, a significant development that marks the first appearance of PPACA-related topics in DOL auditing practices, say Peter Marathas, Howard Shapiro and James Napoli of Proskauer Rose LLP.
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Predictive Coding — Putting The Cart Before The Horse
Many providers and pundits may focus on the Kleen Products LLC v. Packaging Corporation of America case currently pending in Illinois as proof of either judicial acceptance or rejection of predictive coding. But the need for parties to act reasonably in litigation and e-discovery trumps any debate over the use of new technologies, says Christina Zachariason of Navigant Consulting Inc.
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Excise Tax Audits May Add Bite To COBRA Enforcement
Compliance with the Consolidated Omnibus Budget Reconciliation Act has become a critical issue for health plan sponsors as the U.S. Internal Revenue Service moves toward a new COBRA audit effort with updated guidelines that take into account such legislation as the Health Insurance Portability and Accountability Act and the Family and Medical Leave Act, say Lisa Taggart, Russell Chapman and Andrea Jackson of Littler Mendelson PC.