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|The Affordable Care Act—Countdown to Compliance for Employers, Week 18: Emerging Strategies to Reduce or Eliminate Exposure for Assessable Payments under the Affordable Care Act’s Pay-or-Play Rules|
Alden J. Bianchi; Mintz, Levin, Cohn, Ferris, Glovsky and Popeo, P.C.;
September 2, 2014, previously published on August 25, 2014The Affordable Care Act’s employer shared responsibility, or “pay-or-play,” rules require “applicable large employers” (generally employers with 50 or more full-time and full-time equivalent employees) to offer group health plan coverage (i.e., “play”) or...
|End of Year Planning and Compliance Deadlines for Health Plans|
Bret Busacker, John Franklin Clark; Holland & Hart LLP;
September 2, 2014, previously published on August 29, 2014Now that fall is in the air and school has started, we thought this would be a good time to summarize some of the key health and welfare benefit deadlines that are approaching this fall:
|Settlement a Harbinger of Escalating Stark Law Exposure for Physician Compensation?|
Rick L. Hindmand, Jane Pine Wood; McDonald Hopkins LLC;
September 2, 2014, previously published on August 29, 2014A cardiology group practice recently agreed to pay $1.3 million to resolve allegations that it violated the Stark federal physician self-referral law and the False Claims Act by paying its physicians under a compensation formula that considered their referrals for nuclear and CT scans. On Aug. 4,...
|Massive Data Breach Affects 4.5 Million Patients in 29 States|
Dianne J. Bourque, Julia M. Siripurapu; Mintz, Levin, Cohn, Ferris, Glovsky and Popeo, P.C.;
September 1, 2014, previously published on August 20, 2014Community Health Systems, Inc. (the “Company”), one of the largest hospital organizations in the country, announced via a public filing (Form 8K) made yesterday with the Securities and Exchange Commission (“Report”) that the Company was the target of a cyber attack that...
|Healthcare Reform in the U.S. Territories; Prepayment of Taxes for Puerto Rico Retirement Plans|
Karen N. Brandon, Grace Huang Ristuccia; Ogletree, Deakins, Nash, Smoak & Stewart, P.C.;
September 1, 2014, previously published on August 28, 2014The summer of 2014 has brought further guidance for health plan coverage in the U.S. territories and for retirement plan coverage in Puerto Rico. Issuers and employer sponsors of Puerto Rico group health plans and employer sponsors of Puerto Rico retirement plans should review their plans to ensure...
|Two Important Deadlines Approaching for Self-Insured Group Health Plans|
Casey K. Fleming, Leigh C. Riley; Foley & Lardner LLP;
September 1, 2014, previously published on August 26, 2014If you sponsor a self-insured group health plan, then November includes two important deadlines: (1) you must obtain a health plan identifier for your plan, and (2) you must report the number of participants for whom a transitional reinsurance fee is due.
|Eleventh Circuit Rejects Constitutional Challenge to Statute Requiring Medicare Rate Compensation for Services|
F. Ryan Waters; GrayRobinson, P.A.;
September 1, 2014, previously published on August 28, 2014On August 14, 2014, a three judge panel for the Eleventh Circuit Court of Appeals upheld a district court's dismissal of a small, rural hospital's challenge of a federal law requiring hospitals to accept the Medicare rate as compensation when treating federal detainees.
|OIG Finds Risk of Abuse in Specialty Pharmacy’s Per-Fill Fee Proposal|
Rachel Irving Pitts; Mintz, Levin, Cohn, Ferris, Glovsky and Popeo, P.C.;
August 28, 2014, previously published on August 22, 2014In an Advisory Opinion posted August 15, 2014, the Office of Inspector General (“OIG”) concluded that a proposed arrangement by a specialty pharmacy (“Requestor”) might generate prohibited remuneration under the Federal anti-kickback statute and would pose a risk of fraud...
|Another Court Weighs in on Rule 9(b)’s Requirements Under the False Claims Act|
Thomas S. Crane, Brian P. Dunphy, Laurence J. Freedman; Mintz, Levin, Cohn, Ferris, Glovsky and Popeo, P.C.;
August 28, 2014, previously published on August 27, 2014A federal district court recently dismissed a qui tam relator’s complaint in a declined case against the Hospital for Special Surgery (“Hospital”), its former CEO, and an outside billing company alleging that they violated the federal False Claims Act (FCA) and the New York FCA...
|Prescription Drugs: Refocusing the False Claims Act Microscope on the Rest of the Transaction|
Tara E. Swenson; Mintz, Levin, Cohn, Ferris, Glovsky and Popeo, P.C.;
August 28, 2014, previously published on August 25, 2014Over the last decade, it has often felt as though the pharmaceutical industry has been the government’s and whistleblowers’ main, and at times only, target for False Claims Act (“FCA”) investigations. While manufacturers are likely not out from underneath the microscope, it...