Please be advised that contacting Ruder Ware by e-mail does not create an attorney-client relationship. If you contact the firm by e-mail with respect to a matter where the firm does not already represent you, any information which you disclose to us may not be regarded as privileged or confidential.


Accept   Cancel

Please be advised that contacting Ruder Ware by e-mail does not create an attorney-client relationship. If you contact the firm by e-mail with respect to a matter where the firm does not already represent you, any information which you disclose to us may not be regarded as privileged or confidential.


Accept   Cancel

PAL Login

linkedin.jpgyoutube.jpgvimeo.jpgtwitter_off.png View Ruder Ware

Health Care

  • Recent Health Care Legal Developments – Looking Forward to 2017

    Posted on December 29, 2016, Authored by John H. Fisher, II, Filed under Health Care

    As we are coming close to the end of another year, I thought it might be good to pull together some of the health law articles and blogs we produced during 2016.  Ruder Ware's Health Care Focus Team puts out a lot of information on a variety of different blog sites.  This is in addition to our newsletter and our more comprehensive “Blue Paper” seri…   

  • HHS Releases Inflation Adjusted Federal Civil Penalties

    Posted on December 1, 2016, Authored by John H. Fisher, II, Filed under Health Care

    The Department of Health and Human Services has issued new interim final rules to adjust a variety of Federal Civil Penalties for inflation.  The Federal Civil Penalties Inflation Adjustment Act Improvements Act of 2015 required the agency to promulgate a “catch-up adjustment” in these penalties through an interim final rule.  Additionally, HHS age…   

  • When Can Violation of a Condition of Participation Result in False Claims Act Liability? Update on Escobar’s Materiality Standard

    Posted on November 17, 2016, Authored by John H. Fisher, II, Filed under Health Care

    In June, I published a blog article on a decision of the United States Supreme Court that appeared to change the law applicable to “false certification” in the 7th Judicial Circuit Circuit.  The Supreme Court decision in Universal Health Services v. United States ex rel. Escobar, 136 S. Ct. 1989 (2016), (“Escobar”) opened the door to finding liabil…   

  • False Claims Act Basics – Known Overpayment Becomes False Claim

    Posted on November 11, 2016, Authored by John H. Fisher, II, Filed under Health Care

    The Federal False Claims Act (“FCA”) provides a very strong enforcement tool to the federal government.  The FCA also provides the opportunity for whistleblowers to bring “qui tam” cases and collect a portion of the recovery where false claims are proved against the federal government. FCA recovery was originally intended to provide a remedy again…   

  • When Does An Overpayment Become Fraud? How Simple Inattention Can Expose You to Penalties for Fraudulent Activities

    Posted on November 11, 2016, Authored by John H. Fisher, II, Filed under Health Care

    If you are involved in any way in the health care system, it should be obvious by now that the government has committed ever increasing resources to the prosecution of fraud and abuse cases. Simply put, from a governmental standpoint, prosecuting fraud and abuse is good business. Every dollar the government puts into pursuing health care fraud and …   

  • Provider Self-Disclosure Decisions – Voluntary Disclosure Process

    Posted on November 11, 2016, Authored by John H. Fisher, II, Filed under Health Care

    The decision whether or not to voluntarily disclose non-compliance to the government can be very difficult.  Not every case is clear. Clearly not every situation where there has been a billing error amounts to fraud or wrongdoing requiring use of the self-disclosure protocol.  Many overpayments that are identified through audit can be dealt with a…   

  • Lincoln’s Law Becomes Even More Absurd When Applied to the Health Care Industry

    Posted on November 3, 2016, Authored by John H. Fisher, II, Filed under Health Care

    When Congress originally passed the False Claims Act (31 USC §§ 3729-3733), no one had the health care system in mind.  The False Claims Act was also commonly referred to as the “Lincoln Law”.  The original law was focused on unscrupulous vendors who provided overpriced and often faulty supplies to the military during the Civil War.  In modern time…   

  • CMS Releases the First Comprehensive Overhaul of Nursing Home Conditions of Participation in Over 25 Years

    Posted on November 2, 2016, Authored by John H. Fisher, II, Filed under Health Care

    On October 4, 2016, the Center for Medicare and Medicaid Services (CMS) published a final rule to revise the requirements that Long-Term Care facilities must meet to participate in the Medicare and Medicaid programs. CMS states that the revisions to nursing home regulations are intended to reflect the substantial advances that have been made in the…   

  • Ambulatory Surgery Center Compliance Federal Settlement Raises Issues for Physician Owned Surgery Centers

    Posted on September 30, 2014, Authored by John H. Fisher, II, Filed under Health Care

    A Federal Whistleblower that was recently settled in the United States District Court for the Middle District of Tennessee illustrates the difficult issues involved in structuring ambulatory surgery center ("ASC") investments. Specifically, the case demonstrates how investment terms that are intended to assure compliance with the safe harbor regula…   

  • The Role of Confidentiality Agreements in a Corporate Compliance Program

    Posted on June 26, 2014, Authored by John H. Fisher, II, Filed under Health Care

    A recent federal court decision from Pennsylvania illustrates the importance of a confidentiality agreement as part of a compliance program. The Pennsylvania court found that a confidentiality agreement that had been signed by an employee restricted the ability of the whistleblower claimant to use confidential information to support its qui tam cla…   

  • Provider Self Disclosure Process

    Posted on May 22, 2014, Authored by John H. Fisher, II, Filed under Health Care

    A growing area of the health care legal practice involves counseling clients on issues that could require self disclosure under OIG or CMS procedures. The Office of Inspector General has procedures that a provider may follow to disclose possible violations of the Anti-Kickback Statute or other federal laws. Providers have the opportunity to avoid…   

  • Jointly Providing Health Care Fee Information to Payors

    Posted on May 22, 2014, Authored by John H. Fisher, II, Filed under Health Care

    As health care provider networks move down the path toward clinical integration, we are often asked to provide guidance on how information can be jointly provided to payors. The antitrust laws recognize that collective sharing of some pricing information, even by otherwise competing providers, can be beneficial and does not necessarily violate ant…   

  • CMS Changes Meaningful Use Timeline

    Posted on May 21, 2014, Authored by John H. Fisher, II, Filed under Health Care

    The Centers for Medicare and Medicaid Services (CMS) issued a new proposed rule today that changes the timeline for meaningful use electronic health record (EHR) technology. The new proposed rule would be consistent with previous CMS announcement regarding extension of Stage 2 and Stage 3 timelines. The proposed rule recognizes the difficulties t…   

  • OIG Proposes New Civil Monetary Penalty Rules

    Posted on May 19, 2014, Authored by John H. Fisher, II, Filed under Health Care

    On May 12, 2014, the Office of Inspector General (OIG) published a proposed rule that would amend the civil monetary penalty (CMP) rules of the OIG to incorporate new CMP authorities, clarify existing authorities, and reorganize regulations on civil money penalties, assessments, and exclusions. The proposed regulations are intended by the OIG to u…   

  • Messenger Model Contracting - A Structure of the Past

    Posted on May 19, 2014, Authored by John H. Fisher, II, Filed under Health Care

    There are many organizations around the country that use a messenger model as a managed care contracting mechanism. Under the messenger model, an intermediary is used to shuttle offers from managed care organizations to individual providers who sign on to the network. Messenger model networks should not be confused with clinically integrated syste…