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Can an ACO Violate the Antitrust Laws?

Posted on June 21, 2018 by

This may not be obvious to people who do not keep track of the Federal Trade Commission (FTC)/Department of Justice antitrust enforcement policy, but an enforcement action has never been published involving an Accountable Care Organization (ACO) that participates in Managed Security Service Provider (MSSP) or another federal health care program.  The reason for the […]

DOJ Focuses Antitrust Enforcement on Health Care Industry

Posted on June 5, 2018 by

As health care attorneys we are often called upon to consider the antitrust implications in a variety of contracts and transactions.  For example, the establishment of clinically integrated health care networks requires consideration of potential price fixing and exclusionary issues.  The antitrust laws require elements of financial and clinical integration in order to mitigate potential […]

Complying with Michigan’s New Controlled Substance Laws – The Bona-Fide Prescriber-Patient Relationship Requirement

Posted on May 29, 2018 by

The state of Michigan has enacted a number of separate pieces of legislation to address the opioid epidemic.  Most of these laws are directed at controlling the prescribing relationship between a physician and a patient. Generally, Michigan requires a controlled substance license to prescribe controlled substances in the state. A holder of a controlled substance […]

Treatment Center Pleads Guilty to Anti-kickback Statute Violations Involving Alcohol and Drug Addiction Treatment Centers

Posted on May 24, 2018 by

The Department of Justice (DOJ) recently announced the guilty plea of two individual alcohol and substance abuse treatment center owners for their participation in what the DOJ labeled a “multi-million dollar health care fraud and money laundering scheme.”  The two individuals owned a licensed substance abuse service provider (or treatment center) offering clinical treatment services […]

Recent Fraud Settlements Illustrate Current Compliance Risk Areas

Posted on May 17, 2018 by

One of the reasons compliance officers and health care attorneys read fraud settlements is to identify issues the government is focused on.  The cases the government decides to pursue are very indicative of the areas of fraud enforcement they feel are important.  These are not the only issues that should be considered, but government enforcement […]

Office Inspector General Launches New Compliance Resource Portal

Posted on April 30, 2018 by

At a recent Health Care Compliance Association (HCCA) compliance institute, the Office of Inspector General announced it had launched a new resource portal focused on compliance issues.  A trip to the OIG’s web site, and sure enough, there is a brand spankin’ new compliance portal.  You can check out the portal at OIG Portal. On […]

What HIPAA Policies are Required for a Health Care Provider?

Posted on April 4, 2018 by

We are often asked to advise clients regarding the scope and content of Health Insurance Portability and Accountability (HIPAA) policies and procedures that are required to be maintained.  HIPAA clearly requires health care providers, as “covered entities,” to maintain policies and procedures covering HIPAA issues that apply to their operations.  There is a core of […]

When Does a HIPAA Breach Exist?

Posted on April 3, 2018 by

Conducting HIPAA Breach Risk Assessments The HIPAA rules relating to assessment of potential patient confidentiality breaches were changed in 2013.  Specifically, on January 17, 2013, the Office of Civil Rights released new regulations defining when a HIPAA breach is deemed to occur.  These regulations recast the steps that covered entities are required to take when […]

Changes in Federal Enforcement Cases and the Stark Law May Benefit Health Care Providers

Posted on March 16, 2018 by

Some recent changes in federal law and in federal agency interpretation of federal law may both clarify and relieve some regulatory obligations of health care providers. Lessening Dependence on Federal Agency Interpretations of Federal Law In late January, a high ranking official of the U.S. Department of Justice (DOJ) told DOJ litigators they can no […]

Will Centers for Medicare & Medicaid Services (CMS) Really Make Changes to the Stark Law?

Posted on February 26, 2018 by

If you navigate to the American Hospital Association (AHA) Interactive Town Hall of January 17, 2018, you can view a video in which Seema Verma, the current Administrator of the Centers for Medicare and Medicaid Services, discusses some of the efforts currently underway at CMS to ease the burden of applicable regulations through the Medicare […]