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Opening arguments begin today in the second trial in a lawsuit filed by a whistleblower-physician against Tuomey Healthcare System, Inc. (Tuomey). The United States intervened in the matter which alleges that Tuomey entered into part-time employment agreements with 19 physicians that violated the Stark law resulting in False Claims Act (FCA) liability for Tuomey because as the government alleges, that Tuomey took into takes into account the revenue it expected to receive from physicians’ referrals to value the physicians’ base compensation.
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The Stark exception and the Anti-kickback safe harbor that protect electronic health record (EHR) donation to physicians are both set to expire on December 31, 2013. This week, in response to this looming deadline, the Centers for Medicare & Medicaid Services (CMS) introduced a rule that would extend the Stark exception to December 31, 2016. Also this week, the Department of Health and Human Services Office of Inspector General (OIG) introduced a proposed rule extending the Anti-kickback safe harbor to December 31, 2016.
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CMS issued a new rule on March 13, 2013, allowing providers to be paid for services billed under Medicare Part A, which should have been billed under Part B. However, a notice of proposed rulemaking issued the same day states that those claims must still be submitted within a strict one-year window that renders the new rule ineffective.
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Federal Antitrust policy and Accountable Care Organizations” appeared in the American Health Lawyers Association member briefing on Accountable Care Organizations.
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McKesson Corp., Allscripts, athenahealth Inc., Greenway Medical Technologies Inc., RelayHealth, and Cerner announced at the 2013 Healthcare Information and Management Systems Society annual meeting in New Orleans that they have banded together to form an independent trade association.
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On January 17, 2013, the Department of Health and Human Services released the long-awaited final rule modifying the Health Insurance Portability and Accountability Act (HIPAA) regulations. The final rule, at 563 pages, is sure to cause a spike in sales of printer toner.
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On January 17, 2013, the Department of Health and Human Services (HHS) released the long-awaited final rule modifying the Health Insurance Portability and Accountability Act (HIPAA) regulations. The 563-page final rule modifies many aspects of HIPAA. Covered entities and business associates must comply with the new regulations by September 23, 2013.
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Imagine being handed a set of rules to a carnival game and being told that you had to agree to abide by those rules to participate in the game. This carnival game, of course, has prizes that you can win if you follow the rules and, for example, knock down all the bottles. With the prospect of a prize, you pay $5 to throw three balls, knocking down all the bottles. Jumping up and down eagerly awaiting your prize, the carney says you stepped over the line and are disqualified. He sends you packing without an oversized zoo animal to tote on your shoulders. Feeling like you were cheated, you appeal the carney’s decision, arguing that he owes you the giant teddy bear. A panel of your peers (the people in line behind you) rules in your favor with a 2-1 vote, but the carney’s boss disagrees and rejects your appeal. So you sue the carney and his boss for breach of contract. If you could prove that you followed the rules in knocking down the bottles, you would win and be entitled to an overstuffed dust collector because you had a contract. If you are playing the game of hospital medical staff privileges, however, you would lose.
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William Romine went to the emergency room at St. Joseph-Mount Sterling hospital in Mount Sterling, Kentucky, after cutting his hand with a pair of scissors while trying to unclog a bottle of Gorilla Glue. . Romine was not immediately seen at St. Joseph-Mount Sterling because no beds were available. Unsatisfied with having to wait, he left to go to another hospital in Winchester, Kentucky. During the trip to the second hospital, Romine decided to return back to St. Joseph-Mount Sterling, where he was again told there were no available beds. A short while later Romine received treatment to temporarily stop the bleeding. St. Joseph-Mount Sterling determined that it was unable to treat the injury and Romine was airlifted to another hospital where his bleeding was stopped by the placement of sutures.
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On November 30, 2012, the Federal Trade Commission (“FTC”) voted to approve a settlement with the Reno, Nevada health network Renown Health concerning Renown’s acquisition of two cardiology practices in 2010 and 2011. The FTC alleged that Renown’s acquisition of 31 doctors from the two practices gave it control over 88% of the cardiology market in violation of federal antitrust laws.
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