Hospitals & Health Systems

With the passage of the ACA, the voluntary nature of compliance programs is about to change. Smaller healthcare organizations and other ancillary providers who have previously not established compliance programs will now be required to adopt formal programs.  The ACA mandates providers and suppliers participating in federal health care programs to implement compliance programs with “core elements” as a condition of enrollment.

The HHS Secretary is responsible for setting a timeline to implement the new “core elements” for each health care sector and then setting a timeline for providers to adopt compliance programs.  Details regarding the extent of the program have not yet been described or published.  Skilled nursing facilities are the first providers required to implement an effective compliance program by March 23, 2013.

Our Insight.  Your Advantage.  By doing the work now, healthcare organizations can get ahead and avoid surprises when HHS eventually publishes the mandatory compliance program rules for other healthcare sectors. Many in the healthcare industry anticipate the OIG’s voluntary compliance program guidance will serve as an example to HHS as it determines which compliance program elements shall be required.  As you prepare your compliance programs, 

The Missouri Supreme Court has ended the debate over the constitutionality of statutory caps on non-economic damages in common law causes of action, including medical malpractice claims for personal injury. In a 4-3 decision returned on July 31, 2012, the court in Watts v. Lester E. Cox Medical Centers found that the right to a…

In a 2-1 decision in Sodexo America LLC, the National Labor Relations Board (NLRB) held recently that the University of Southern California hospital violated Section 8(a)(1) of the National Labor Relations Act by maintaining and enforcing a rule that limited off-duty employee access to the workplace, except for specific purposes.

The policy at issue provided that:

  1. Off-duty employees are not allowed to enter or re-enter the interior of the hospital or any other work area outside the hospital except to visit a patient, receive medical treatment or to conduct hospital-related business.
  2. An off-duty employee is defined as an employee who has completed his/her assigned shift.
  3. Hospital-related business is defined as the pursuit of the employee’s normal duties or duties as specifically directed by management.
  4. Any employee who violates this policy will be subject to disciplinary action.

On June 25, 2012, the U.S. Supreme Court granted the Federal Trade Commission’s request for certiorari review in FTC v. Phoebe Putney Health System, Inc., a hospital merger case on appeal from the U.S. Eleventh Circuit Court of Appeals and the U.S. District Court for the Middle District of Georgia.

At issue in the case is the FTC’s challenge to a hospital merger that would give the acquiring health system 100% market share in its county and more than 90% market share of the multi-county region in rural southern Georgia.  Applying the state action doctrine, both the trial court and the Eleventh Circuit held that the merger of two private hospitals, Phoebe Putney Memorial Hospital and Palmyra Park Hospital, was immune from antitrust laws even though all parties agreed that the merger created a monopoly.  State action immunity applies when a policy that displaces competition is “clearly articulated” and “actively supervised” by the state.  The doctrine can extend to private actors when they act pursuant to a clearly articulated state policy to displace competition, and they are actively supervised by the state.  Clear articulation is found when a restraint of trade is a “foreseeable” consequence of the action taken by the state.   

Husch Blackwell Healthcare Department Chair Curt Chase and his co-presenters explore common hospital/physician relationships that generate serious and complex compliance issues at HCCA’s 16th Annual Compliance Institute in Las Vegas, NV.  They provide methods for effectively auditing, managing and conducting internal investigations and evaluate disclosure options and appropriate fixes.

To read the presentation, click below.

Pete Enko and Steve James presented a webinar on HIPAA HITECH enforcement including breach notification requirements, response strategies and what to expect with upcoming HIPAA audits.

To watch a recording of this webinar, click here.

If you have any questions regarding these materials, please contact  Pete Enko (816-983-8312 or pete.enko@huschblackwell.com) or Steve

Husch Blackwell Healthcare Department Chair Curt Chase presented at the American College of Healthcare Executives’ 2012 Congress on Healthcare Leadership in Chicago, IL.  Curt and his co-presenters discuss the various issues impacting successful hospital/physician integration efforts in light of healthcare reform and changes to reimbursement methodologies. They explore a full range of integration alternatives including…

CMS has, in the past, expressed concern regarding the use of concierge medicine by physicians treating Medicare patients.  CMS has prosecuted some concierge care practices for charging concierge fees for “non-covered services” under Medicare.  Despite this opposition, patients and physicians have increasingly implemented concierge-like relationships, including amenities that provide unlimited access to physicians via email,…