BY Jacque K. Steelman and Michael R. Alexander, Brown & Fortunato, P.C.   The Centers for Medicare & Medicaid Services (“CMS”) recently finalized the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) (the “Rule”). The Rule requires a number of federally funded payers (“Payers”) to implement and maintain application programming interfaces (“APIs”). These APIs are intended to improve the electronic exchange of healthcare data and streamline the authorization process required by payers for specific procedures...

BY Michael Alexander, Esq., Brown & Fortunato, P.C.   Periodically, and it seems with greater frequency, I open my work email to find an email that just stands out as being odd in one form or another. Due to my generally conservative approach to technological issues, I do not understand, my immediate response is to forward the message along to our firm’s IT expert. Occasionally he will respond that the email is legitimate, and I...

BY Blinn E. Combs, Esq and Michael Alexander, Esq., Brown & Fortunato, P.C. On November 14, two plaintiffs lodged a class action suit against UnitedHealth Group, Inc. (“United”) in the U.S. District Court in Minnesota, where United is headquartered. The complaint alleges that United used artificial intelligence (“AI”) to illegally deny coverage to potentially thousands of United customers who had purchased Medicare Advantage plans from the insurer. The suit is a fresh reminder of AI’s...

BY Phuong D. Nguyen, Esq. and Michael Alexander, Esq., Brown & Fortunato, P.C.   During the 88th legislative session, Texas passed HB 3162 to update the state’s requirements for advance directives. The new law added granular detail to the various procedures associated with advance directives and do-not-resuscitate (“DNR”) orders, set specific timeframes for certain notices and events, and imposed new reporting requirements on health care facilities. The new law became effective as of September 1,...

BY Kianna Sitarski, Brown & Fortunato, P.C.   Even before the onset of the COVID-19 Pandemic, hospitals and other healthcare facilities faced funding and workforce shortages. Predictably, the funding and workforce issues of the industry were further exacerbated by the demands of the pandemic.   To help alleviate the financial pressure that many patients, hospitals, and healthcare facilities face, United States Senators Bernie Sanders and Roger Marshall, MD, recently introduced a bill named the Bipartisan...

BY Colleen Byrom, Brown & Fortunato   Today most hospitals and healthcare providers utilize websites and mobile applications (“mobile apps”) to give their patients easier access to their medical information. However, behind these technologies may lie certain tools that result in the provider violating the Health Insurance Portability and Accountability Act of 1996’s (“HIPAA”).  In fact, the U.S. Department of Health and Human Services (“HHS”), Office for Civil Rights (“OCR”) recently shifted their focus on...

BY Rossanna J. Madrigal, Senior Attorney, Brown & Fortunato   The U.S. Supreme Court (Court) heard and opined on a pair of False Claims Act (FCA) cases in June 2023 that could have lasting impacts on how providers defend against FCA cases.   The FCA imposes liability on a person that knowingly presents a false or fraudulent claim for payment or approval. To violate the FCA, one must submit a false claim and, importantly, know...

By Beth Anne Jackson and Jacque Mayes, Brown & Fortunato   Texas HB 1998, signed into law by Governor Abbott on June 13, 2023, and effective September 1, 2023, enacts broad-ranging changes to the Texas Occupations Code that not only significantly alters peer review reporting requirements and the confidentiality of reports regarding disciplinary actions against physicians, but also makes it more difficult for physicians to become licensed and renew their registration in Texas. The Health...

BY Colleen Byrom and Beth Anne Jackson, Brown, and Fortunato   The political battle between state abortion laws and federal laws and regulations wages on as providers struggle to remain in compliance with both sets of laws. Texas’s abortion law is no exception and has faced its own enforcement challenges. The newest challenge on the horizon comes in the form of modifications to the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule regulations.  ...

BY Kianna Sitarski and Beth Anne Jackson, Brown & Fortunato   Healthcare providers are now facing increased scrutiny from the United States Department of Justice (DOJ) and the Federal Trade Commission (FTC) when it comes to antitrust enforcement in the context of mergers, acquisitions and other collaborations. On February 3, 2023, the DOJ issued a policy statement that withdrew previous DOJ-FTC joint guidance issued in 1993, 1996, and 2011 (Guidance) that provided “antitrust safety zones”...