The growth in prescription drug coverage has led to increased complexity in the delivery and reimbursement of medications. PBMs are organizations which address this complexity by impacting most aspects of the pharmaceutical supply chain.
Cori Turner
Cori’s experience as a hospital and hospice volunteer inspired her to pursue a legal career that also serves patients. Husch Blackwell, with one of the largest U.S. healthcare practices, was a natural fit.
Dismantling the Affordable Care Act (ACA) adversely impacts kids’ health coverage
According to an article published by USA Today, nearly $1 trillion in federal cuts to the Medicaid program approved by House Republicans threaten getting low income and special needs children covered by insurance. Concerns are magnified by the Sept. 30 deadline for CHIP reauthorization, which some worry will be used as a bargaining tool to…
Children’s hospital to pay $12.9 million to settle alleged False Claims Act violations
The District of Columbia reached a settlement agreement with Children’s Hospital, Children’s National Medical Center Inc. and its affiliates (collectively, “CNMC”) on June 15, 2015, to resolve allegations that CNMC violated the False Claims Act by submitting false cost reports and other applications to the U.S. Department of Health & Human Services (“HHS”) as well as to the Virginia and District of Columbia Medicaid programs. Further details can be found in the Department of Justice’s press release announcing the settlement.
Grady Health System to pay over $2.9 million to settle claims of alleged inflated Medicaid NICU billing
The state of Georgia reached a civil settlement agreement on April 23, 2015, with Grady Health System based on allegations that Grady incorrectly coded claims for neonatal intensive care unit (NICU) patients, resulting in overpayments by Georgia Medicaid. For more details, read the Georgia Attorney General’s press release announcing the settlement.
Briefing explores legal aspects of marijuana applications in pediatric healthcare
Husch Blackwell Partner Winn Halverhout authored a briefing on the emerging use of medical marijuana in pediatric healthcare for the American Health Lawyers Association. The briefing, titled “Legal Aspects of Marijuana Applications in Pediatric Health Care,” addresses the development of state laws and cultural acceptance of marijuana.
Don’t let research on ‘little’ subjects get you in big trouble
Over the last few decades, the healthcare industry has come to recognize that research on children is necessary to determine the safest and most effective treatments for pediatric patients. Whether your institution is part of a nationally renowned research program or participates in a few pharmaceutical research studies a year, the following two issues are critical when structuring research studies that involve pediatric patients.
Celebrating Women’s Leadership
In 2012, several American Health Lawyers Association (AHLA) members and leaders expressed interest in developing informal networking and professional development opportunities for women members and program attendees. After receiving feedback from informal in-person networking events held at the 2012 Annual Meeting and the 2012 Fraud and Compliance Forum, an AHLA Women’s Network took shape and in January 2014, the Women’s Leadership Council formalized the operation of the Network.
This year’s quarterly series of interviews with some of AHLA’s women members was designed with the intent to give young professional members an opportunity to profile some of our more experienced or uniquely situated AHLA members and leaders, to learn more about their path to success, and challenges they have faced along the way.
Organizations Aim to Standardize Telehealth Practices
The Federation of State Medical Boards recently endorsed a model policy that addresses the proper use of telemedicine services. Only a few weeks later, a not-for-profit foundation released a report highlighting the benefits of telemedicine and making recommendations for telehealth services. It’s no surprise that telehealth and telemedicine have been in the news with increasing frequency given that the demand for telemedicine services are rising sharply. According to a Law360 article, Deloitte Touche Tohmatsu Ltd. estimates that 75 million digital doctor visits will occur this year in North America.
Children’s Hospitals: Don’t Lose Sight of These Issues in the OIG’s 2014 Work Report
The HHS OIG released its Work Plan for FY 2014 three months ago and is hard at work investigating the issues highlighted in its annual publication. The OIG’s annual Work Plan lists current and new projects it will address during 2014, and is an excellent source for healthcare facilities to use in identifying potential compliance risk areas. The Work Plan has a number of items that impact children’s hospitals. Whether you immediately added these issues to your organization’s list of potential risk areas or still haven’t had the opportunity to review this year’s Work Plan, we recommend that you do not lose sight of these issues.
Are Internal Investigations Protected by the Attorney-Client Privilege and Work Product Doctrine? Recent Case Says Maybe Not.
On March 6, 2014, the District Court for the District of Columbia issued an opinion in United States ex rel. Barko v. Halliburton Company et al. requiring Kellogg, Brown & Root Engineering Corporation (“KBR”) to produce documents originally withheld on the basis of attorney-client privilege and the work product doctrine. The Court found that the documents, which related to internal investigations of possible violations of KBR’s code of conduct, were ordinary business records created to satisfy regulatory requirements and were not created for purposes of obtaining or receiving legal advice. The Court’s decision was based on the fact that KBR’s internal investigation was required under the Federal Acquisition Regulation and internal KBR policy, and that the investigation was conducted by non-lawyers. The Court’s holding raises significant questions about existing corporate compliance and investigation programs in regulated industries, including healthcare.
In Barko, the plaintiff brought a qui tam complaint alleging that KBR employees subcontracted to certain third parties who inflated invoices for substandard work, resulting in overcharges to the government. Barko sought, in the course of discovery, documentation from the internal review performed by KBR’s Office of Business Conduct into these allegations. After an in camera review of the documents at issue, the Court determined that the documents were not protected.