Supreme Court Strikes North Carolina Law On Recoveries From Third-Party Settlements

The U.S. Supreme Court March 20 ruled 6-3 that a North Carolina Medicaid lien statute that allowed the state to recoup medical expenses from an injured patient’s tort recovery is preempted by the Medicaid Act’s “anti-lien” provision (Wos v. E.M.A., U.S., No. 12-98, 3/20/13).
The court affirmed a federal appeals court ruling that struck down the state law under which North Carolina could recover all of its Medicaid expenditures, up to one-third of the total amount recovered by a Medicaid recipient in a judgment against, or settlement with, a third party responsible for the recipient’s injuries. The court ruled that the state law violated the act’s anti-lien provision, 42 U.S.C. § 1396p(a)(1).

Read the entire article here.

March 21st, 2013

FTC, Idaho Attorney General Challenge Hospital’s Acquisition of Practice Group

The completed acquisition of Idaho’s largest independent, multispecialty physician practice group, Saltzer Medical Group PA, by St. Luke’s Health System Ltd. is anti-competitive and violates state and federal antitrust laws, according to a complaint filed jointly by the Federal Trade Commission and the Idaho attorney general March 12 (FTC v. St. Luke’s Health System Ltd., D. Idaho, No. 13-cv-116, 3/12/13).

According to an FTC statement, the complaint, which was filed under seal in the U.S. District Court for the District of Idaho, charges that the acquisition gives the combined entity enough market power to demand higher rates for certain health care services. The joint complaint alleged that the combination was anti-competitive and violated Clayton Act § 7 and Section 48-106 of the Idaho Competition Act.

The private antitrust litigation over the medical group’s acquisition by St. Luke’s was brought by Saint Alphonsus in November 2012 and gave rise to the federal court’s decision refusing to grant a preliminary injunction (Saint Alphonsus Medical Center-Nampa Inc. v. St. Luke’s Health System Ltd, D. Idaho, No. 1:12-cv-560-BLW, 12/20/12).
Read the entire article here.

March 14th, 2013

California Hospital Must Answer Claims That Nurses Failed to Obtain Proper Consent

A California hospital whose nurses failed to adequately explain the risks of a medical procedure to family members of a woman who suffered complications and eventually died as a result of the procedure may be liable for damages, a state appeals court said Jan. 30 in reversing summary judgment for the hospital (Gonsalves v. Sharp Healthcare, Cal. Ct. App., No. D060514, unpublished 1/30/13).

Read the entire article here.

February 14th, 2013

DOJ Settles Claims With Missouri Clinic Charged With Turning Away Patient With HIV

A settlement announced by the Department of Justice Feb. 6 requires Castlewood Treatment Center LLC, an eating disorder clinic in St. Louis, to pay $140,000 and bring its policies into compliance with the Americans with Disabilities Act.
The agreement, reached as part of DOJ’s Barrier-Free Health Care Initiative, resolves charges that the clinic violated the ADA by refusing to treat a woman, Susan Gibson, for a serious eating disorder because she has HIV. According to the settlement, DOJ found evidence that Castlewood refused to treat Gibson because of her HIV, even though the clinic had determined that she was eligible for the clinic’s counseling services and even though its medical staff determined that she could be treated safely there.
Read the entire article here.

February 13th, 2013

Business Associate Contracts

A “business associate” is a person or entity, other than a member of the workforce of a covered entity, who performs functions or activities on behalf of, or provides certain services to, a covered entity that involve access by the business associate to protected health information. A “business associate” also is a subcontractor that creates, receives, maintains, or transmits protected health information on behalf of another business associate. The HIPAA Rules generally require that covered entities and business associates enter into contracts with their business associates to ensure that the business associates will appropriately safeguard protected health information. The business associate contract also serves to clarify and limit, as appropriate, the permissible uses and disclosures of protected health information by the business associate, based on the relationship between the parties and the activities or services being performed by the business associate. A business associate may use or disclose protected health information only as permitted or required by its business associate contract or as required by law. A business associate is directly liable under the HIPAA Rules and subject to civil and, in some cases, criminal penalties for making uses and disclosures of protected health information that are not authorized by its contract or required by law. A business associate also is directly liable and subject to civil penalties for failing to safeguard electronic protected health information in accordance with the HIPAA Security Rule.


February 4th, 2013

HHS Says 106 New Accountable Care Organizations Formed Under Medicare

The Department of Health and Human Services Jan. 10 said that physicians and health care providers have been approved to offer 106 new accountable care organizations in 2013 under the Medicare Shared Savings Program.
That brings the total number of ACOs established since 2012 to more than 250, serving about 4 million beneficiaries, the department said in a press release.
HHS said 15 of the ACOs approved were Advance Payment Model ACOs, which it said are physician-based or rural providers who receive advance payments to help cover costs of establishing the infrastructure needed to coordinate care for their beneficiaries.

Read the entire article here.

January 17th, 2013

AMA, State Physician Groups Call for End to ICD-10 Implementation

The American Medical Association, along with 42 state medical organizations and 40 medical speciality groups, urged the Centers for Medicare & Medicaid Services to cancel implementation of the ICD-10 code set, according to a letter sent in late December.

Read the entire article here.

January 16th, 2013

North Carolina Hospital to Pay $8 Million

RALEIGH, N.C.—WakeMed, a Raleigh-based not-for-profit hospital system, has agreed under a deferred prosecution agreement to pay $8 million to settle allegations it falsely billed Medicare for inpatient stays, federal prosecutors announced Dec. 19, 2012 (United States v. WakeMed E.D.N.C. No. 5:12-cr-398, settlement 12/19/12).

Read the entire article here.

January 14th, 2013

Pfizer to Pay 33 States $42.9 Million

RALEIGH, N.C.—Pfizer Inc. has agreed to pay $42.9 million to settle allegations that it unlawfully promoted two of its drugs, several state attorneys general announced Dec. 12, 2012. As part of the settlement it reached with 32 states and the District of Columbia, Pfizer also agreed to change how it markets the drugs at issue, Zyvox and Lyrica.

Read the entire article here.

January 11th, 2013

Pfizer Resolves Drug Promotion Allegations

The Department of Justice Dec. 12, 2012, announced that Pfizer Inc. will pay $55 million plus interest to resolve allegations that its Wyeth unit promoted the drug Protonix for unapproved uses (United States v. Wyeth LLC, D. Mass., docket number unavailable, settlement announced 12/12/12).

Read the entire article here.

January 10th, 2013

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