On February 27, 2023, a jury in Minnesota federal court rendered a verdict in favor of the United States and against a surgical product distributor following a False Claims Act jury trial that lasted six weeks.[1] The jury identified $43 million in Medicare payments flowing from 64,575 kickback-procured claims.
In the world of qui tams, it is usually the whistleblower pushing cases to trial. But on February 23, 2023, a federal judge in West Virginia set down for trial a hospital’s case against a whistleblower. Now, in a trial set for late March 2023, a jury is set to determine whether a whistleblower and the general counsel for a competing health system engaged in malicious prosecution and tortious interference by filing a qui tam against a West Virginia hospital.
Stories can be powerful tools. Stories can create a sense of connection and have the power to shape the lives of both the storyteller and the listener. Stories also make ideas and experiences relatable and can encourage exploration or action. And it was the stories I heard from members of AHLA’s Women’s Leadership Council that inspired me to write this column as a reminder of the incredible impact of AHLA’s educational mission supported by AHLA’s philanthropic initiatives.
Continue Reading Women’s Network—Storytelling: AHLA’s Educational and Philanthropic Mission
On July 26, 2022, Judge Jeremy Kernodle of the Eastern District of Texas affirmed that certain parts of the Interim Final Rule Part II implementing the No Surprises Act (the Act) were invalid. This ruling is nearly identical to Judge Kernodle’s February decision in Texas Medical Association & Corley v. US Dept. of Health and Human Services. This decision vacated a portion of the Interim Final Rule that required arbitrators to give more weight to the out-of-network rate, including what is called the Qualified Payment Amount (QPA), over other permissible factors. The rule’s requirement ultimately contradicted the Act’s direction that arbitrators consider various factors, and not weight any one more heavily than another.
Continue Reading Eastern District of Texas Invalidates Parts of Implementing the No Surprises Act
Workplace violence has become a hot topic in today’s discourse; however, workplace violence is not just headline fodder for media outlets. The trend is well-documented and especially felt by the healthcare industry which continues to experience the brunt after the onslaught of COVID-19. In 2018, 73% of all nonfatal workplace violence incidents involved healthcare workers. A late 2020 survey reported that 20% of nurses reported they were facing an increase in workplace violence after the COVID-19 pandemic began. Another study reported a 14.6% increase in workplace violence at New Jersey hospitals over the prior three years.
Continue Reading Code Blue! — Violence in the Workplace
As the health care industry shifts from fee-for-service to value-based arrangements, providers are facing a lot of challenges. A provider’s relationship with payers is often strained by the new business model, and a provider’s ability to collaborate with payers has never been more important.
On this episode of Value-Based Care Insights, host Daniel J. Marino
When confronted with a complaint, allegation or event that implicates a potential Medicare overpayment, hospices have an affirmative duty under the federal 60-day repayment rule to conduct an investigation and refund any overpayment. In this episode, Husch Blackwell’s Meg Pekarske and Andrew Brenton share tips and tools for conducting internal investigations and determining when an
The American Health Law Association released its Special Edition of its Journal of Health and Life Sciences Law on Emerging Issues in Health Equity in the United State: Legal, Legislative, and Policy Perspectives. The association strives to advance public discourse on these issues for the benefit of AHLA members, the public, academia, and decision makers in both the legislative and executive branches of government.
Continue Reading American Health Law Association New Publication on Emerging Issues in Health Equity in the U.S.: Legal, Legislative, and Policy Perspectives
The U.S. Department of Justice’s recent criminal prosecutions of health care executives for no-poach and wage-fixing conspiracies have been met with not-guilty verdicts. Despite these losses, the Department continues to prosecute this conduct, and antitrust enforcers will continue to investigate human resources practices that may restrain competition.
Continue Reading Two Strikes for DOJ: Health Care Executives Not Guilty of Antitrust Conspiracies
The Acute Care Hospital at Home model (ACHAH) provides traditional hospital inpatient acute-level services at home. Prior to the pandemic a Centers for Medicare and Medicaid pilot study yielded positive results with respect to hospital readmission rates and follow-up emergency department visits. The ACHAH model appears to be a feasible alternative to traditional inpatient acute care that can improve quality of care and patient satisfaction. What was previously a trickle of interest turned into a wave of necessity as the pandemic overwhelmed hospitals and the health care system in 2020. In response to the pandemic, CMS began to provide hospital with broad regulatory flexibility to implement the ACHAH model.
Continue Reading The Future of Hospital at Home