Federal court decision ends medical records scheme

By Beth Anne Jackson, Esq. and Allison Shelton, Esq. After a decision in Ciox Health Care LLC v. Alex Azar (Ciox) in January, health care providers will no longer be required to subsidize the provision of copies of medical records used by plaintiff attorneys to prove malpractice, personal injury and similar cases. The scheme was hatched after the Office of Civil Rights (OCR) published guidance in 2016 (Guidance) regarding patients’ ability to request that records...

First false claims act settlement of 2020 and trends from 2019 in Department of Justice settlements

By Elizabeth H. Jepson, Esq. and Beth Anne Jackson, Esq. In fiscal year 2019 (FY 2019), which ended September 30, 2019, the U.S. Department of Justice (DOJ) recovered over $2.6 billion in civil health care fraud actions.  This amount comprises the vast majority of the more than $3 billion recovered by DOJ in all civil fraud cases in FY 2019.  And early in January 2020, DOJ announced its first civil health care settlement of the...

Health system pays $2.175 million to settle claims under HIPAA

By Allison Shelton and Elizabeth Jepson, Brown & Fortunato, P.C.   Health care providers typically have some discretion in determining whether an incident is reportable under the Health Insurance Portability and Accountability Act (HIPAA). However, providers should take care in exercising such discretion. As evidenced by a recent settlement between a hospital system and the Office for Civil Rights (OCR), a provider’s decision to not report an incident, may result in significant costs. Subject to certain exceptions,...

New rules requiring disclosure of health care pricing

By Beth Anne Jackson and Elizabeth H. Jepson, Brown & Fortunato, P.C.   On November 15, 2019, the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) issued two rules to increase pricing transparency and competition among hospitals, group health plans, and health insurance issuers.  The first rule was issued in final form (the 2020 Pricing Transparency Requirements), and the second was released as a proposed rule...

Proposed regulations seek to reduce risk of value-based arrangements

By Beth Anne Jackson and Allison D. Shelton, Brown & Fortunato, P.C.   On October 17, 2019, two agencies within the U.S. Department of Health and Human Services (HHS) finally proposed rules (Proposed Rules) intended to reduce the regulatory risk of value-based arrangements (VBAs) in health care. Specifically, the Centers for Medicare and Medicaid Services (CMS) proposed new exceptions to the physician self-referral law (Stark Law). Meanwhile, the Office of Inspector General (OIG) proposed changes...

Texas amends data breach laws and creates new short-lived privacy council

By Elizabeth Jepson and Beth Anne Jackson On June 14, 2019, Texas Governor Greg Abbott signed into law House Bill 4390 (HB 4390), which is bipartisan legislation amending the Texas state breach notification law. HB 4390 places a strict deadline on the breach notification requirements set forth in the Texas Identity Theft Enforcement and Protection Act (TITEPA), requires notification of the Texas Attorney General of a breach affecting more than 250 Texas residents, and creates...

Conditions of participation: The new landscape of hospital co-location

BY Elizabeth Jepson and Allison Shelton   On May 3, 2019, the Centers for Medicare and Medicaid Services (CMS) released draft guidance for hospitals and other healthcare providers addressing co-location.  This guidance is CMS’ first formal policy on co-location and provides insight into how CMS will evaluate co-locating providers’ compliance with Medicare’s conditions of participation (“CoPs”).   Co-location refers to the sharing of space, staff, and services between separate entities, such as two hospitals or...

Texas legislative session: What you should know

By Allison D. Shelton and Beth Anne Jackson, Brown & Fortunato, P.C.   On May 27, 2019, the Texas 86th Legislature ended its regular session that began on January 8, 2019. After five months of committee proceedings, debates, and votes, the 86th Legislature passed 484 bills.  Several of the bills that were signed by Governor Greg Abbott will impact the health care industry.   Two bills, Senate Bill (SB) 749 and SB 1264, refine processes...

Can peer review result in hospital liability for employment discrimination?

BY Beth Anne Jackson and Allison D. Shelton, Brown & Fortunato, P.C.   Recently, a 7th Circuit Court of Appeals case, Levitin v. Northwest Community Hospital (Levitin), concluded that a physician whose medical staff privileges were terminated could not sue the hospital for discrimination under Title VII because the hospital was  not the physician’s employer.   The physician had claimed that the hospital’s use of the peer review process exerted  sufficient control to grant it “employer”...

CBD: Legal status and clinical practice issues

By Beth Anne Jackson and Elizabeth Jepson, Brown & Fortunato, P.C. With the passage of the Agriculture Improvement Act of 2018 (Farm Bill) in December 2018, Congress established a new category of cannabis: hemp, which is defined as cannabis with 0.3 percent or less concentration of compound delta-9-tetrahydrocannabinol (THC).  Further, the Farm Bill specified that the definition of the term “marihuana” under the Controlled Substance Act does not include “hemp.”   Many assumed that the...

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