DOJ Probing Humana Medical Claims, Doctor Loans in Fla.,
Law360, May 1, 2012
On April 30, 2012 Human Inc. announced that the U.S. Department of
Justice had opened an investigation into it and its affiliates'
loans to physician practices and their coding of medical claims.
Humana Inc. indicated that it received requests for documents and
information pertaining to such loans and claims and that it may
face litigation regarding the Medicare and Medicaid operations of
certain of its Florida subsidiaries.
NY Hospital Pays $11.75M To End Medicare Turbocharge Suit,
Law360, May 4, 2012
On May 4, 2012, Lenox Hill Hospital agreed to pay $11.75 million to
settle False Claims Act allegations that had been made against it.
The government claimed that Lennox Hill Hospital had fraudulently
increased charges for inpatient care and that Lennox Hill Hospital
had manufactured excessive outlier payments.
Federal Trade Commission Seeks Supreme Court Review of
Hospital Merger Decision , Law360, May 3, 2012
In late March 2012, the FTC requested the Solicitor General of the
United States to petition the U.S. Supreme Court to review a ruling
by the Eleventh Circuit concerning Phoebe Putney Health System
Inc.'s acquisition of Palmyra Park Hospital in Albany, Georgia.
In a decision FTC Chairman Jon Leibowitz recently criticized as
being "jarringly wrong," the Eleventh Circuit ruled that
Phoebe's acquisition was shielded by the state action doctrine.
Phoebe has until May 23, 2012 to file its response to the FTC's
petition for certiorari.
Promoting Competition in the Health Care Industry Remains a
High Priority for The Department of Justice's New Antitrust
Chief , Law360, May 3, 2012
In his first speech since being appointed Acting Assistant Attorney
General for the Antitrust Division, Joseph Wayland indicated that
the DOJ will continue to monitor consolidation and scrutinize
most-favored nation clauses and unilateral conduct in the health
care industry. Before taking over the Antitrust Division, Mr.
Wayland led the Division's first successful litigated merger
challenge in nearly a decade, obtaining a permanent injunction
blocking H&R Block Inc's attempted acquisition of its rival
TaxAct. He also led the Antitrust Division's challenge to
AT&T's proposed acquisition of T-Mobile, which the parties
ultimately abandoned after months of litigation.
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The Centers for Medicare & Medicaid Services and the Department of Health and Human Services Office of Inspector General have recently published parallel proposed rules revising, respectively, the Stark exception and Anti-Kickback safe harbor concerning electronic health record items and services.
CMS wants to change the way that it rewards non-qui tam whistleblowers who report alleged fraudulent or unlawful conduct related to Medicare or Medicaid.
Marilyn Tavenner received bipartisan support from members of the Senate Committee on Finance in her confirmation hearing to lead the Centers for Medicare and Medicaid Services (CMS) though a full Senate vote is being held up, the president released his FY 2014 budget proposal with health care reform and specified reimbursement reductions to providers and manufacturers totaling $400 billion over 10 years sprinkled throughout it, and Department of Health and Human Services (HHS) Secretary Sebelius
Understanding the complexities of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Security Rules is often a challenge for health care providers and consumers.
The news from the Office of the National Coordinator for Health IT (ONC) about the revocation of the electronic health record (EHR) certifications of two EHR products that had previously been certified will have tremendous ramifications not only on the EHR vendor losing its certifications, but generally on providers and vendors as well.
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