By Terry Roman On February 24, a Republican draft reconciliation bill was leaked to Politico. While it hasn’t been introduced or acknowledged by House Republicans it provides the most comprehensive look so far at how House Republicans plan to change the Affordable Care Act (ACA). First, what does it not do. The bill does not […]
In 2014, Las Vegas urologist, Dr. Michael Kaplan, was convicted by a federal jury for reusing single-use plastic needle guides during prostate biopsies. He was convicted of conspiracy to commit adulteration in violation of the Federal Food, Drug, and Cosmetic Act (“FDCA”), 21 USC Section 331(k) with the intent to defraud or mislead, and sentenced […]
The Physician Self-Referral Law, also known as the Stark law, prohibits a physician from referring federal health care program patients for “designated health services” to an entity in which the physician (or an immediate family member) has a financial relationship, unless an exception applies. Financial relationships include both ownership and investment interests, as well as […]
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 […]
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 […]
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 […]
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 […]
