Health Law Monitor

Supreme Court Confirms Government’s Discretion to Dismiss Qui Tam False Claim Act Lawsuits

July 7, 2023

On June 16, 2023, the United States Supreme Court handed down its decision in U.S. ex rel. Polansky v. Executive Health Resources, No. 21-1052.  The decision may have a lasting impact on the quickly growing False Claims Act (“FCA”) qui tam litigation throughout the United States.

In Polansky, the Supreme Court held that the federal government has the authority to dismiss an FCA suit in which it…

Expansion of HIPAA Privacy Rule for Reproductive Health Care

May 11, 2023

On April 17, 2023, the Department of Health and Human Services (the “Department”) issued a Notice of Proposed Rulemaking (“NPRM”) proposing to expand protections afforded by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule following recent legal events involving reproductive health care.[1]

This NPRM aims to strengthen the Privacy Rule protections by prohibiting…

West Virginia Health Law 2023 Legislative Update

April 21, 2023

West Virginia Health Law 2023 Legislative Update

The 2023 Regular Session of the West Virginia Legislature was not short on headlines, and bills impacting the health care industry often took center stage. During the last week of March 2023, all completed legislation that the governor had not already signed became law.  This occurred via a West Virginia constitutional provision that automatically…

With an Extension Likely, Telehealth Seems Here to Stay

October 6, 2022

Telehealth is a growing trend in medicine.  From 2019 to 2020, telehealth use increased an eye-popping 3000%, not including Medicaid and Medicare claims.  Although the claims have decreased slightly as of 2021, telehealth is clearly here to stay and with it comes new challenges.

What is Telehealth?

For the purposes of Medicare, “telehealth services” are “professional consultations, office visits,…

SCOTUS Says a Medicare Patient is Included in the DSH Medicare Fraction Even if Medicare Does Not Pay

August 25, 2022

Earlier this summer, the Supreme Court issued an opinion in Becerra v. Empire Health Foundation, a case where a hospital challenged the Department of Health and Human Services (“HHS”) interpretation of a 2004 regulation affecting the way Medicare’s disproportionate share hospital (“DSH”) adjustments are calculated. The Supreme Court upheld HHS’s interpretation, much to the disappointment of the…

WV Supreme Court Reinforces Mandatory Pre-Suit Requirements in Medical Professional Liability Actions

July 12, 2022

West Virginia’s Medical Professional Liability Act (MPLA), W. Va. Code 55-7B-6(b), provides that at least thirty days before filing suit, a claimant must serve two pre-suit documents - a Notice of Claim and a Certificate of Merit - on each health care provider they intend to sue.  Timely compliance with the statute can “toll” or extend the applicable statute of limitations.  In Adkins v. Clark, No.…

Creating Cultural Responsiveness in the Colorado Healthcare Network

May 6, 2022

Beginning January 1, 2023, the Colorado Option Plan will go into effect. Under the Colorado Option Plan, private insurers will be required to offer a standardized insurance plan that offers certain health care services and dictates the services that insureds could receive without paying towards the deductible to the counties in which insurers already sell plans to the individual and small group…

"Play Ball" - The No Surprises Act Update: Third Installment

October 27, 2021

Congress enacted the No Surprises Act (the “Act”) to protect patients against “surprise bills,” while at the same time respecting a provider’s ability to receive remuneration for services rendered. In this third installment of the series (first installment and second installment), we provide an update that the Department of Health and Human Services (“HHS”) together with the Department of Labor…

"Play Ball" - The No Surprises Act and Requirements Related to Surprise Billing: The Second Installment

August 17, 2021

As detailed in an earlier blog post, Congress enacted the No Surprises Act (“Act”) to protect patients against “surprise bills.” A surprise bill occurs when a patient receives health care services from an out-of-network provider. It can occur in both emergency and non-emergency situations, although frequently it occurs during emergency situations when a patient does not choose the facility or…

Going Public? Colorado's "Public" Health Insurance Plan

June 9, 2021

House Bill 21-1232 or the “public option bill” is before the Colorado legislature for the second time and the numerous rounds of rewrites have changed the character of the bill itself. Initially proposed as a public health insurance plan offered by the state, the bill now seeks to mandate a standardized health insurance plan that is operated by private insurers. If approved, the public option…

The Time is Now: Enforcement for Discrimination Based on Sexual Orientation and Gender Identity Begins

May 13, 2021

On May 10, 2021, the U.S. Department of Health and Human Services (HHS) announced that the Office of Civil Rights (OCR) will interpret and enforce Section 1557 and Title IX’s prohibition on discrimination based on sex to include both (1) discrimination on the basis of sexual orientation and (2) discrimination on the basis of gender identity. 

OCR is responsible for enforcing Section 1557 of the…

The Winds of Change - Defining Value in Healthcare

December 14, 2020

On November 20th, 2020, the Centers for Medicare & Medicaid Services (CMS) made sweeping changes to the Stark Law through the issuance of a new “Final Rule,” which is an essential mile-marker in the government’s Sprint to Coordinated Care.  Many industry stakeholders have been eagerly awaiting the Final Rule’s issuance, hoping that it would provide more flexibility and clarity to this complex…