HHS Nondiscrimination Regulations Challenged in Federal Court

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On August 23, 2016, eight plaintiffs jointly sued the federal Department of Health and Human Services (“HHS”) disputing the definition of the term “sex” in recent HHS regulations implementing the Affordable Care Act’s (“ACA”) non-discrimination provisions. A link to the Complaint is here.  The HHS regulations, which, among other things,... Continue Reading →

EEOC Advances Cause of Transgender Employee Seeking Insurance Coverage from Hospital System for Sex Transformation Surgery

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Sex Transformation Surgery In a lawsuit filed in June in the Northern District of California, an operating room nurse claims that his hospital system employer, because of his sex, refused to provide insurance coverage related to his sex transformation. The plaintiff alleges that the hospital’s conduct violates both Title VII... Continue Reading →

Proposed Michigan Legislation to Prohibit Physician Maintenance of Certification in Privileging and Credentialing

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Late last year, Rep. Edward Canfield (R-Sebewaing) and Sen. Peter MacGregor (R-Rockford) proposed legislation that would amend: (1) the Public Health Code to prohibit the Department of Licensing and Regulatory Affairs or a professional board from requiring a physician to maintain a national or regional certification and prohibits hospitals from... Continue Reading →



OCR Announces Largest Single-Entity Settlement to Date

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On August 4, the Office for Civil Rights (“OCR”) announced a $5.55 million settlement with the largest fully integrated health care system in Illinois. The settlement is the largest HIPAA settlement ever by a single entity and follows two recent settlements with university health systems in Oregon and Mississippi that... Continue Reading →

Reminder: Critical Access Hospitals in Counties that Changed to Urban in 2014 Must Reclassify as Rural by September 30, 2016

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On August 5, 2014, the Centers for Medicare & Medicaid Services (“CMS”) issued an Inpatient Prospective Payment System (“IPPS”) Final Rule (“Final Rule”) adopting the updated labor market area delineations based on the 2010 census. The updated labor market area delineations became effective October 1, 2014. The Final Rule effectively... Continue Reading →

9th Circuit Issues Blockbuster Medicare Advantage FCA Decision

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The 9th Circuit Court of Appeals just issued a blockbuster ruling in U.S. ex rel. Swoben v United Healthcare et al., ruling that United Healthcare, WellPoint, Aetna and other major health insurance providers must answer to a whistleblower’s complaint that they defrauded the Medicare Advantage program. The Medicare Advantage Program,... Continue Reading →

Mandatory Federal Remedies for Nursing Homes

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On July 22, 2016, the Center for Clinical Standards and Quality/Survey & Certification Group released a memorandum that revised Chapter 7 of the State Operations Manual (“SOM”) and provided guidance on its policy to immediately impose federal remedies when a deficiency of a certain type is cited. The remedies are... Continue Reading →

OIG Issues Favorable Advisory Opinion on Prescription Drug Discount Program

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The Department of Health and Human Services Office of Inspector General (“OIG”) recently issued a favorable Advisory Opinion, No. 16-07, of an arrangement that offers Medicare Part D beneficiaries discounts on prescriptions for an erectile dysfunction drug that is statutorily excluded from coverage under Part D (the “Arrangement”). While OIG... Continue Reading →