DOJ Settlement Reached in Medicare Kickback Case

In a settlement agreement reached with the U.S. Department of Justice (DOJ), Health Diagnostic Laboratories, Inc. (HDL) and Singulex Inc. will pay a combined $48.5 million to the DOJ to resolve allegations that it violated the False Claims Act and federal Anti-Kickback […]

Injunction Upheld Regarding Missouri’s Health Insurance Marketplace Innovation Act

Enacted in 2013, the Missouri Health Insurance Marketplace Innovation Act (HIMIA) took steps to strictly regulate specific factors within the state health insurance industry. Specifically, the Act, which was established under the passing of HB 701, imposed further licensing standards on insurance navigators […]

OIG’s Possible Sanctions for Exclusive Service Agreements

Exclusive service agreements are designed to establish a loyal relationship between two partners. Specifically, these agreements act as covenants providing that, in the case of a service provider and a user, the user will procure services from the provider, and […]

Rumble v. Fairview Health Services – Court Opinion on Transgender Discrimination Important for Health Care Groups

In June of 2013, a patient checked into a hospital emergency department with complaints that his reproductive organs were causing him extreme pain. The patient identifies as a male, but was given a hospital identification bracelet stating that he was […]

CMS Releases Its Stage 3 Proposed Rule Regarding Meaningful Use

On March 20th, the Centers for Medicare & Medicaid Services (CMS) issued its Stage 3 proposed rule to the Medicare and Medicaid Electronic Health Records Incentive Program.  To qualify for the Program incentives, and to avoid negative payment adjustments absent […]

New IRS Penalty Relief for Small Employer Health Insurance Premium Payment Plans

Business owners nationwide have been scrambling to find ways to adhere to the rules and regulations set forth in the Affordable Care Act (ACA),which was enactedin 2010. Of course, many of the provisions regulating small businesses and theirowners did not […]

CMS Releases New ACO Model

The Affordable Care Act (ACA) encouraged doctors, health care providers, and other medical professionals to participate in Accountable Care Organizations(ACOs), which are groups of medical professionals and healthcare providers that voluntarily unite to offer comprehensive treatment to Medicare beneficiaries.Specifically, the Medicare […]

Hospital Can’t Fire for Conduct During Peer Review

In order to provide the highest quality of care, and to ensure patient safety on the premises, hospitals throughout the country use a system of peer reviews to assess medical staff. Specifically, a group of employed medical professionals,acting as a professional review […]