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HTMLThe 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.;
Legal Alert/Article
September 2, 2014, previously published on August 25, 2014
The 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...

 

HTMLEnd of Year Planning and Compliance Deadlines for Health Plans
Bret Busacker, John Franklin Clark; Holland & Hart LLP;
Legal Alert/Article
September 2, 2014, previously published on August 29, 2014
Now 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:

 

HTMLSettlement a Harbinger of Escalating Stark Law Exposure for Physician Compensation?
Rick L. Hindmand, Jane Pine Wood; McDonald Hopkins LLC;
Legal Alert/Article
September 2, 2014, previously published on August 29, 2014
A 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,...

 

HTMLMassive 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.;
Legal Alert/Article
September 1, 2014, previously published on August 20, 2014
Community 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...

 

HTMLHealthcare 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.;
Legal Alert/Article
September 1, 2014, previously published on August 28, 2014
The 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...

 

HTMLTwo Important Deadlines Approaching for Self-Insured Group Health Plans
Casey K. Fleming, Leigh C. Riley; Foley & Lardner LLP;
Legal Alert/Article
September 1, 2014, previously published on August 26, 2014
If 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.

 

HTMLEleventh Circuit Rejects Constitutional Challenge to Statute Requiring Medicare Rate Compensation for Services
F. Ryan Waters; GrayRobinson, P.A.;
Legal Alert/Article
September 1, 2014, previously published on August 28, 2014
On 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.

 

HTMLOIG Finds Risk of Abuse in Specialty Pharmacy’s Per-Fill Fee Proposal
Rachel Irving Pitts; Mintz, Levin, Cohn, Ferris, Glovsky and Popeo, P.C.;
Legal Alert/Article
August 28, 2014, previously published on August 22, 2014
In 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...

 

HTMLAnother 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.;
Legal Alert/Article
August 28, 2014, previously published on August 27, 2014
A 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...

 

HTMLPrescription 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.;
Legal Alert/Article
August 28, 2014, previously published on August 25, 2014
Over 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...

 


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