2014 OIG Work Plan Released: Our Observations on Enforcement

Posted by Jason Greis on February 19, 2014 under Articles | Be the First to Comment

The Office of the Inspector General (“OIG”) of the Department of Health and Human Services (“HHS”) recently released its Work Plan for Fiscal Year 2014 (the “Work Plan”).  Usually issued in October, budget pressures delayed this year’s release.  The Work Plan provides an annual view into the OIG’s planned areas of focus for investigation and enforcement activities in the coming year.  Below are a few interesting observations from this year’s Work Plan. Read More...

MedPAC Votes Again to Recommend an 8-Day ICU Length of Stay to Qualify for LTCH-PPS Payments

Posted by Jason Greis on February 11, 2014 under Articles | Be the First to Comment

In January 2014, the Medicare Payment Advisory Commission (MedPAC), a commission that provides non-binding but influential recommendations to Congress on Medicare issues and related payment policies, voted to recommend for Congress to pass legislation requiring an 8-day length of patient stay in an intensive care unit (ICU) of a general acute care hospital before admission to a Long Term Care Hospital (LTCH) would trigger higher reimbursement to LTCHs under the Long-Term Care Hospital Prospective Payment System (LTCH-PPS). Read More...

Impact of the Bipartisan Budget Act of 2013 on LTACHs: Six Key Changes

Posted by Jason Greis on December 18, 2013 under Articles | Be the First to Comment

With Congress having adopted its first budget resolution in several years, many questions have arisen as to what the legislation means for the federal government, businesses and individual taxpayers. In order to understand the budget deal, it is important to consider the context within which the agreement was reached, as well as the specific provisions it contains. Doing so allows for a more effective examination of the goals and potential impact of this significant, albeit incremental, measure. Read More...

Tuomey Ordered to Pay $237.5 Million for Stark and False Claims Act Violations: Key Lessons for Providers

Posted by Jason Greis on October 7, 2013 under Articles | Be the First to Comment

Nearly eight years to the day since the case was filed, Senior U.S. District Judge Margaret B. Seymour ordered Tuomey Healthcare System to pay more than $237.5 million in False Claims Act (FCA) fines and Stark Law penalties. Originally brought as a qui tam (whistleblower) action, this order now threatens Tuomey’s financial survival. Unless overturned on appeal, Tuomey must pay $237.5 million for the Stark and FCA violations, more than its total revenue last year. As part of her ruling, Judge Seymour also rejected Tuomey’s motions for a new trial. Read More...

Post-Acute Sector Transaction Activity Increasing in the Second Half of 2013

Posted by Jason Greis on September 30, 2013 under Articles | Be the First to Comment

Over the past several years, the healthcare industry has experienced a significant increase in private equity and alternative investment and industry consolidation—trends that have only accelerated with implementation of pay-for-performance initiatives, payment reductions that favor lower-cost care settings and integrated care-delivery models (i.e. accountable care organizations, medical homes and bundled care) that promise to aggregate care and reduce costs across multiple sites of service.  In 2012, for example, private equity firms invested approximately $4 billion in health or medical services and the number and value of private equity deals throughout the healthcare industry accounted for roughly 11% of all deals consummated worldwide. Read More...

Wake Up Call for Providers: Flurry of Settlements with Healthcare Facilities for Failures to Provide Auxiliary Aids to Disabled Individuals

Posted by Jason Greis on April 25, 2013 under Articles | Be the First to Comment

In April 2013, the U.S. Department of Justice (DOJ) announced the settlement of five investigations with healthcare providers concerning access to services for persons who are deaf and hard of hearing.  These recent settlements stem from the DOJ’s ongoing partnership between the Civil Rights Division and U.S. Attorneys’ offices nationwide. This partnership, announced in July 2012, is designed to target enforcement efforts of healthcare facilities to ensure that people with disabilities, especially those who are deaf or hard of hearing, have equal access to medical services. The five newly announced settlements – one with a hospital, two with rehabilitation centers, and two with private specialty practices – highlight the continuing focus on healthcare providers of all sizes and their policies and practices when providing medical information to deaf and hard of hearing patients or companions. Read More...