The pandemic forced us to reevaluate how we work. In an effort to reduce the risk of exposure to COVID-19, we shifted a large portion of our workforce to remote status. This provided an opportunity not just to increase the safety of our workforce, but also to see if a...
Health & Health Care Law
Surgical group fights back when DOJ claims collusion
The Department of Justice (DOJ) recently accused a surgical group out of Texas of illegal collusion with competitors. According to the feds, the group agreed not to poach senior-level employees from competing practices. The group is composed of physicians who own and...
Feds ask for $200M in overpayments from Medicare Advantage group
In what the Health and Human Services Office of Inspector General is calling the largest audit penalty every imposed on a Medicare Advantage company, the feds have recently completed and an audit and are calling on the company to pay over $200 million back in Medicare...
Anatomy of an HHS audit
The United States Department of Health and Human Services (HHS) recently announced updates to its Phase 2 Health Insurance Portability and Accountability Act (HIPAA) Audit Program. These audits aim to check for an entity’s compliance with certain requirements. The...
What can a practice do when it loses privileges at a hospital system?
Medical practices depend on relationships with hospital systems. An abrupt end to privileges within a hospital can have a catastrophic impact on the group and the patients they serve. Unfortunately, these situations are not uncommon. Most recently, a group out of St....
Government takes steps to add oversite to pharmaceutical mergers
The Federal Trade Commission (FTC), U.S. Department of Justice Antitrust Division, and offices of state attorneys general along with the Canadian Competition Bureau, European Commission Directorate General for Competition, and U.K.’s Competition and Markets...
NY to insurance providers, cannot deny claims for administrative reasons
In a recent win for hospitals throughout the state, the New York Department of Financial services recently stated insurance providers cannot deny hospital claims based on “administrative reasons.” More specifically, the letter states that insurance provers cannot deny...
Medical board investigation can be beginning of bigger problems
An investigation by your state medical board is a big deal. It can lead to steep fines and even a revocation of your medical license, making it impossible to continue your practice in that state. Unfortunately, this could just be the beginning. In some cases, an...
What should hospital administrators know about recent data breaches?
United States Department of Health and Human Services (HHS) reports that healthcare breaches increased by over 55% in 2020. This translates to a jump from a reported 386 breaches in 2019 to 599 in 2020. The vast majority of these incidents were the result of hacking...
Arbitration to appeals, the long road of an FCA violation claim
A federal court recently ordered Tenet Healthcare, a multi-national investor owned healthcare services company based out of Dallas, Texas, to pay $10 million to two cardiologists. The ruling stems from a whistleblower case. In this case, the two cardiologists accused...