Health Law Checkup

About this Blog

The SW Health Law Checkup is written by the attorneys of Snell & Wilmer to provide their insight on an array of regulatory and compliance matters related to federal and state fraud and abuse laws and regulations, reimbursement, credentialing and employment of providers, joint ventures and physician-entity integration, best practices in compensation and contracting, value-based purchasing and contracting with providers.

Arizona Supreme Court Confirms Abolishment of Original Tortfeasor Rule

For more than thirty years, Arizona law has allowed juries to allocate fault among all who contribute to an injury. On July 18, 2016, the Arizona Supreme Court unanimously re-affirmed Arizona’s commitment to “comparative fault” by reversing a trial court’s decision that attempted to reconcile “full allocation” of fault with a much older doctrine that […]

| 4 min read
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More (MACRA) Data Analysis, Please

On July 1, CMS finalized new MACRA rules that significantly expand how qualified data entities will be allowed to share or sell analyses of Medicare and private claims data to providers, insurers, employers, and others who, in turn, can use the data to support improved care.  In announcing the new rules, CMS’ Chief Data Officer, […]

| 4 min read | Tagged: ,
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Supreme Court Unanimously Adopts “Implied Certification” Theory of False Claims Act (“FCA”) Liability

On June 16, 2016, the U.S. Supreme Court in Universal Health Services, Inc. v. United States, ex. rel. Escobar, U.S. No. 15-17, 06/16/2016, ruled unanimously in an opinion written by Justice Thomas that the “implied false certification theory” can be a basis for FCA liability. This theory treats a provider’s payment request as provider’s implied […]

| 4 min read
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Risk Corridor Payment Litigation

Highmark Inc. and some of its health insurance affiliates (“Highmark”) recently filed a lawsuit in the U.S. Court of Federal Claims seeking to recover damages for the federal government’s failure to make risk corridor payments to insurers with high claims costs due to the insurer’s participation in the health care exchanges created by the Patient […]

| 2 min read
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Internal Revenue Service Denies Tax-Exempt Status for a Commercial ACO

In April 2016, the Internal Revenue Service (the “Service”) issued a final determination denying a nonprofit corporation (the “Network”) tax exempt status under Section 501(c)(3) of the Internal Revenue Code (the “Code”).[1]  The private letter ruling involved a tax-exempt health system (the “System”) that formed the Network to operate an accountable care organization (“ACO”) that […]

| 4 min read
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Key issues to watch in the MACRA Proposed Rule

The MACRA Proposed Rule details CMS’ new payment approach, which emphasizes and rewards the use of interoperable health information technology by physicians and other Medicare Part B clinicians and that steers clinicians toward alternative payment models.  The Proposed Rule would establish key parameters for the new Quality Payment Program, a framework that includes the Merit-based […]

| 3 min read | Tagged:
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