Health Care Archives

Apr 27, 2023

How A Hospital Can Assure That It Will Be Required To Pay Punitive Damages

During the federal fiscal year ending in September, 2022, the Department of Justice collected more than $1.7 billion in False Claims Act (FCA) settlements and judgments involving fraud in Medicaid, Medicare Advantage (MA) overpayments, unlawful kickbacks and substandard care. In our experience working with hospitals, the significant financial penalties associated with FCA violations usually provide a powerful incentive for the hospitals to engage in careful diligence in structuring the terms of acquisitions of physician practices, the structure of physician relationships, and physician compensation formulas in compliance with healthcare regulatory requirements so as to avoid exposure to liability for violations of… Read more

Jul 5, 2022

SCOTUS: Prosecutors Must Prove “Subjective” Knowledge to Convict Doctors Under the Controlled Substances Act

On June 27, 2022, the United States Supreme Court clarified the “knowingly or intentionally” standard for criminal prosecutions against doctors accused of overprescribing addictive medications in violation of the Controlled Substances Act. In Ruan v. United States and Kahn v. United States, federal prosecutors accused two licensed doctors of illegally prescribing large volumes of opioid painkillers to patients. The cases arose under 21 U.S.C. § 841, which makes it a crime: (1) except as authorized; (2) knowingly or intentionally; (3) to manufacture, distribute, or dispense… a controlled substance. For background, the prosecution must prove that the defendant “knowingly” broke the… Read more

Dec 17, 2018

ACA Ruled Unconstitutional By Texas Court-What’s Next?

HRA: Health Reimbursement Arrangements ACA

Hours before the end of annual enrollment in the federal health care exchanges under the Affordable Care Act (ACA), a Texas district court judge ruled that the ACA is unconstitutional because the ACA’s individual mandate was eliminated. (The individual mandate is reduced to zero on January 1, 2019.) In Texas vs. United States, Judge Reed C. O’Connor struck down the law, siding with a group of 18 Republican state attorneys general and two GOP governors that the tax bill passed by Congress last December effectively rendered the entire ACA unconstitutional. Judge O’Connor ruled that, because the U.S. Supreme Court upheld… Read more

Nov 7, 2018

Breaking News: Post-Election IRS Issues Final ACA Rule Regarding Religious Exemptions

The IRS has just released new final regulations regarding religious exemptions and accommodations from the contraceptive coverage mandate of the Affordable Care Act (ACA). The rule, to be officially published on November 15th, currently in unpublished form, is available here. This final rule, released post-midterm elections, will provide a way forward for religious organizations that object to certain contraceptive coverage required under the ACA. More details soon.

Jun 21, 2018

Excited About Association Health Plans?

Not So Fast, Says New York and Massachusetts Many commentators and businesses welcomed the new final regulations on association health plans (AHPs) released by the US. Department of Labor (DOL) on Tuesday, (see here and here). The new rules allow small businesses and self-employed individuals to band together to purchase health insurance, even across state lines. This insurance potentially is more cost-effective than the current Affordable Care Act (ACA) marketplace policies, and the policies offered to the small group and individual markets. These policies may be less expensive because the AHPs are not required to provide all of the essential benefits required under the… Read more

Jun 20, 2018

Association Health Plans Reinvigorated-New Options for Many Employers

White House: Executive Order Reinvigorates Association Health Plans

Association Health Plans have been reinvigorated by the new regulations released yesterday by the U.S. Department of Labor (DOL). As I mentioned in my blog entry yesterday, these regulations are the result of President Trump’s executive order last year instructing the DOL to allow for more flexibility related to the Affordable Care Act (ACA), and health insurance. As we are parsing the 198 pages of comments and final regulations, it is clear that the final regulations loosen many restrictions on “association health plans” (AHPs). Now, more small businesses, including self-employed (sole proprietors) employers, can either become members of, or even establish… Read more

Jun 19, 2018

Breaking News: New Association Health Plans Rules Expand Health Care Options

Today, the US Department of Labor (DOL) released new association health plans (AHPs) rules that allow small employers and self-employed individuals to join together to purchase health insurance coverage. These rules are the result of President Trump’s executive order last year requesting the DOL to provide more access and choice in the health insurance market, including the AHP regulations. As the DOL stated in the press release accompanying the regulations “under the Department’s new rule, AHPs can serve employers in a city, county, state, or a multi-state metropolitan area, or a particular industry nationwide”. This includes self-employed individuals who now… Read more

Jun 14, 2018

Judge Says “No” to ACA Reimbursements for Insurers

Today, a Federal Judge ruled that the Federal government does not need to reimburse insurance companies for over $12 billion in the “risk corridor” program under the Affordable Care Act (ACA). As background, the risk corridor program was designed to lessen financial losses for insurers during the initial years of the ACA. However, Congressional Republicans have likened this program to a “bail-out” for insurance companies and were instrumental in blocking its funding. The Federal Circuit Court agreed that Congress could lawfully withhold funding from this program. While this decision applies only to the cases brought by health insurers Moda Health Plan and… Read more

Jun 13, 2018

Will the ACA be Dismantled in Court? Justice Department Declines to Support ACA Provisions

President Trump’s administration continues in its mission to dismantle the Affordable Care Act (ACA). While attempts to repeal the ACA through legislation have not succeeded, the constitutionality of the ACA is again under assault. In an unusual move, Attorney General Jeff Sessions sent a letter to congressional leaders, telling them that the Justice Department will not defend the constitutionality of certain ACA provisions in the lawsuit filed in the Northern District Court in Texas by 20 State Attorney Generals. The letter stated in part that “The department in the past has declined to defend a statute in cases in which… Read more

Dec 20, 2017

Health Care Implications of Tax Bill: No More Individual Mandate

Late yesterday, the U.S. Senate Republicans approved a tax bill, by a vote of 51-48. This bill was previously approved by the U.S. House by a vote of 227-203. As the bill must be identical in both chambers, this bill now heads back to the U.S. House to correct three provisions. One of these provisions is the actual name of the bill. The Senate version’s short title, the “Tax Cuts and Jobs Act,” must be known as “An Act to provide for reconciliation pursuant to titles II and V of the concurrent resolution on the budget for fiscal year 2018,”… Read more