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Waller Healthcare Blog
DOL Asks D.C. Circ. For Quick Approval Of Home Care Rule
By Mark Peters | 09-04-2015
Since October 2013, when the Department of Labor issued a Final Rule extending overtime and minimum-wage protections to most home care workers previously deemed exempt, the home health industry has been on pins and needles.

FTC Releases Guidelines Regarding Unfair Methods of Competition
By Beth Vessel | 08-20-2015
On August 13, 2015, the FTC released its Statement of Enforcement Principles Regarding Unfair Methods of Competition Under the FTC Act.

Hospital Board Members and Trustees Can be an Effective Ally for the CEO
By Fletcher Brown | 08-05-2015
Last week, we presented on the challenges faced by hospital boards at the annual Healthcare Governance Conference presented by Texas Healthcare Trustees. Rural hospitals in Texas and elsewhere face more legal and financial challenges than ever before

CMS Issues Proposed Stark Law Modifications
By Kristen A. Larremore | 08-04-2015
In July, CMS published a draft update to the Medicare Physician Fee Schedule for 2016, which included proposals that aim “to reduce burden and to facilitate compliance” under the physician self-referral law known as the Stark Law.

New Jersey Case Wakes Up the Nonprofit Hospital Industry - What the Morristown Case Means for Hospital Property Tax Exemptions
By Donald B. Stuart | 08-03-2015
Nonprofit hospital executives and lawyers throughout the country have been taking notice of a recent tax court case out of New Jersey involving the Morristown Medical Center.

Senator Grassley Takes Notice of OIG Reports Alleging Fraud in Pediatric Dental Practices
By J.D. Thomas | 07-27-2015
Sen. Grassley recently sent a letter to United States Attorney General Loretta Lynch asking her to detail the DOJ’s investigation and enforcement efforts with regard to Medicaid dental fraud.

A Healthy Dose of Data Security Awareness
By Steve Blumenthal | 07-22-2015
At Waller’s latest Healthcare and Big Data panel discussion, we were joined by industry experts to discuss healthcare data breaches. While data security threats arise in a variety of contexts, the risk of healthcare data breaches can be reduced thr

CMS Prepared to Modify Controversial Two-Midnight Rule
By Fletcher Brown, J.D. Thomas | 07-17-2015
Earlier this month, CMS released the Hospital Outpatient Prospective Payment System (HOPPS) Proposed Rule for CY 2016. While there are a number of payment updates proposed in the plan, the two-midnight rule is garnering most of the attention.

Tuomey Decision Signals Concerns About Stark Law
By J.D. Thomas, Meredith Toole | 07-16-2015
Earlier this month, the Fourth Circuit federal appeals court upheld a district court’s $237 million FCA verdict against Tuomey Healthcare System for Stark Law violations. The sum is believed to be the largest ever levied against a community hospita

What CMS’ Proposed Bundled Payment Rule for Elective Hip and Knee Replacements Could Mean for Providers
By Denise Burke, Tyson Bickley | 07-15-2015
Yesterday, CMS published a proposed rule - called the Comprehensive Care for Joint Replacement (CCJR) Model - which would implement a mandatory bundled payment program for elective hip and knee replacements in 75 geographical areas.

House Passes 21st Century Cures Act
By Michael Staley | 07-10-2015
Today, the U.S. House of Representatives passed H.R. 6, the 21st Century Cures Act, with a bipartisan vote of 344-77. The legislation is intended to accelerate “the discovery, development and delivery of life saving and life improving therapies.”

Tom Scully Highlights Need for Post-Acute Care Reform at Leadership Health Care
By J.D. Thomas | 06-30-2015
Recently, Nashville’s Leadership Health Care hosted several healthcare leaders to hear Tom Scully, general partner at private equity firm Welsh, Carson, Anderson & Stowe and chairman of naviHealth, on the state of the post-acute space and key refor

Supreme Court Saves Affordable Care Act (Again): 6-3 Decision Upholds Subsidies in King v. Burwell
By Shannon Goff Kukulka | 06-26-2015
6.5 Million Americans, 34 States, Investors (and Maybe Even Republicans) Breathe Collective Sigh of Relief

King v. Burwell - Supreme Court Affirms Fourth Circuit Decision in Favor of Nationwide Subsidies
By | 06-25-2015
In a 6-3 decision, the Supreme Court affirmed the Fourth Circuit decision in King v. Burwell. The majority opinion noted that "Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them."

OIG Issues Fraud Alert Targeting Physician Compensation
By Angela Youngberg | 06-23-2015
The Office of the Inspector General issued a Fraud Alert on June 9, 2015 that highlights the OIG’s intent to continue and to strengthen its focus on physicians who enter into questionable compensation arrangements with hospitals, nursing homes and

Congress Opens the Medicare Data Toolbox
By Steve Blumenthal | 06-22-2015
The “Doc Fix” law includes a few subtle lines that may expand the use of Medicare claims data to develop new models of patient care.

Long Sentences in Healthcare Fraud and Other White Collar Cases Combined with Increased Criminal Investigation of False Claims Act Cases Make for a Potentially Explosive Combination
By J.D. Thomas | 06-16-2015
Last week the former president of Riverside General Hospital in Houston was sentenced to 45 years in prison and ordered to pay restitution in excess of $46 million for his role in a $158 million Medicare fraud scheme involving illegal kickbacks and r

Setting the Stage for Interoperability
By Steve Blumenthal | 06-11-2015
The “Doc Fix” got most of the coverage when Congress passed the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), but the bill also established numerous requirements and deadlines with respect to achieving interoperability with health

OIG Issues Latest Report Targeting Dental Providers
By J.D. Thomas | 05-26-2015
The Office of the Inspector General (OIG) has issued its latest report in its state-by-state series examining pediatric dental services provided under Medicaid. This newest report examines such practices in California.

What Hospitals Can Learn from Recent Florida Settlements over Ambulance Rides
By J.D. Thomas | 05-15-2015
The U.S. Attorney's Office for the Middle District of Florida announced that nine Florida hospitals have agreed to pay $6.2 million to settle allegations that they led ambulance companies to bill for medically unnecessary rides.

Advocates and Critics Contemplate 21st Century Cures Act
By Elizabeth Sillay | 05-14-2015
Over the last year, the U.S. House Energy and Commerce (E&C) Committee has engaged in a broad public conversation about what steps can be taken to bridge the gap between advancements in science and the approval of new medical therapies, and how to re

Financial Experts Discuss Deal-Making Trends
By Morgan Ribeiro | 05-08-2015
Recent reports continue to show that deal volume in the healthcare industry is at an all-time high. The Nashville Health Care Council continued this ongoing discussion during its “Financing the Deal” event.

New Tennessee Law Provides Patient Access to Interchangeable Biologic Medicines
By Hunter Rost | 05-08-2015
Tennessee Governor Bill Haslam this week signed TN Senate Bill 984 into law, creating a clear pathway for pharmacists in Tennessee to substitute an FDA-approved “interchangeable biological product” for a prescribed biological product.

Creating a Mutually Beneficial Relationship between Innovators and Institutions
By Kristen Johns | 05-07-2015
Medical and administrative know-how and inventions are positively impacting patient care, patient costs and hospital revenue. Yet almost all of the formalized programs to transfer technology are within major university-affiliated hospitals.

April Showers Brought Changes to Telehealth Laws
By Angela Youngberg | 05-05-2015
Telehealth is exploding in both popularity and use as it has been shown to be convenient, affordable and of high quality. On both a federal and Tennessee level, the field of telehealth continues to gain attention and garner changes in the law.

Considerations for Hospitals and Health Systems on Commercializing Innovations
By Kristen Johns | 04-30-2015
One opportunity that is sometimes overlooked by health systems is the commercialization of innovations conceived by the physicians and staff providing care.

Obama Administration Warns States that Failing to Expand Medicaid Could Jeopardize Funding to Pay for Treating the Poor
By Angela Youngberg | 04-29-2015
Tennessee was recently added to the list of states that have been warned by the Obama administration that failing to expand Medicaid under the Affordable Care Act could jeopardize special funding to pay providers for treating the poor.

The Rise of Hospital Joint Ventures: A Q&A with Juniper Advisory’s Rex Burgdorfer
By Ken Marlow | 04-28-2015
Hospital joint ventures have progressed significantly over the past several years; they are now a viable option to help organizations provide services or enter markets they would otherwise be unable to access.

HIMSS15: It Was All About the Pie
By Steven Blumenthal | 04-23-2015
Nearly 43,000 people descended upon Chicago last week for the annual HIMSS meeting. We've recapped some of the biggest events of the week and key topics of discussion.

SGR Formula Comes to a Close
By Angela Youngberg | 04-20-2015
In a rare bipartisanship vote, the “doc-fix” bill that cleared the Senate and was signed by President Obama last week put the 15-year-old sustainable growth-rate (SGR) formula to an end.

What is Net Neutrality and Why Should You Care?
By Angela Youngberg | 04-14-2015
The controversial Internet rules will forbid Internet service providers to speed up, slow down or block a consumer’s access to any particular content.The policy is particularly relevant to healthcare.

Fade to Black … for Now? The Twisting Tale of Telemedicine in Texas
By Mark Folk | 04-13-2015
On Friday, April 10, the Texas Medical Board voted to limit severely the ability of physicians in the state to provide two fundamental components of primary medical care via telemedicine.

Tips on and Trends in Healthcare IT Investments
By Rob Harris, Tyson Bickley | 04-02-2015
On Tuesday, Waller hosted the second installment of our Healthcare and Big Data panel series. We were joined by Vic Gatto of Jumpstart Foundry, Jesse Bland of the Heritage Group, and William Seibels of Change Healthcare.

Hurry Up and Wait: Senate Says “Not So Fast” to the Sustainable Growth Rate Bill
By Angela Youngberg | 03-27-2015
After yesterday’s passage by the U.S. House of a bill eliminating the sustainable growth-rate (“SGR”) formula (otherwise known as the “doc fix”), the Senate leaders decided they’d rather think about the bill after Spring Break.

Biosimilars on the Agenda as Life Science Tennessee Visits the State Legislature
By Hunter Rost | 03-19-2015
Members of Life Science Tennessee were in Nashville yesterday for the organization’s annual legislative “Day on the Hill” at the Tennessee General Assembly. A key element of the group’s state policy agenda focuses on “biosimilars".

MedPAC Issues 2015 Report to Congress
By Denise Burke, Angela Youngberg | 03-18-2015
Last week, MedPAC – the Medicare Payment Advisory Commission – issued its annual report to Congress on the Medicare fee-for-service (FFS) payment systems, the Medicare Advantage program, and the Medicare prescription drug program (Part D).

Has the Supreme Court Opened a Door for New Challenges to State Corporate Practice of Medicine Laws?
By Neil Krugman, Don Moody | 03-13-2015
The Supreme Court’s recent 6-3 decision in North Carolina Board of Dental Examiners v. Federal Trade Commission is noteworthy for its possible effects on the way state boards or agencies license and regulate dental and medical practitioners.

Tufts Health Plan Announces New Hampshire Joint Venture with Granite Healthcare Network
By Brian Browder | 03-13-2015
Earlier this week, Tufts Health Plan announced that it will create a New Hampshire-based insurance company called Tufts Health Freedom Plan in a joint venture with Granite Healthcare Network (GHN).

An Update from Leadership Health Care’s Delegation to D.C.
By J.D. Thomas, Cory Brown | 03-13-2015
Earlier this week, we attended the Leadership Health Care delegation to Washington, D.C., where we were joined by 100 of our fellow Nashville healthcare industry friends to learn more about the policy and politics shaping our industry this year.

Four Little Words and a Potential “Death Spiral” - Supreme Court Hears Challenge to Affordable Care Act Subsidies in King v. Burwell
By Shannon Goff Kukulka | 03-05-2015
The Supreme Court heard oral arguments in King v. Burwell this week. The subsidies at issue in the case are a critical piece of the ACA's architecture that a ruling for the petitioners would likely be the death knell for the ACA itself.

Alignment Continues for Providers and Insurers
By Brian Browder | 02-23-2015
More providers are partnering with payors to position themselves for population health management. We foresee several potential obstacles, however, to the success of this collaboration among competitors.

A Few Thoughts on Compliance from a Former Assistant U.S. Attorney
By J.D. Thomas | 02-20-2015
The only thing worse than no compliance program is one that’s in place but isn’t followed. Companies need to take internal communications seriously, and the complaints that are received should not be ignored.

Denial of St. Luke's Appeal Shows Importance of Competitive Review of Transactions
By Beth Vessel | 02-16-2015
In a widely anticipated decision, the Ninth Circuit affirmed the decision of the U.S. District Court for the District of Idaho ordering divestiture of St. Luke’s 2012 acquisition of Nampa, Idaho-based Saltzer Medical Group.

Healthcare Fraud Enforcement and the DOJ’s Greatest Hits
By J.D. Thomas | 02-09-2015
In 2014, the department of justice obtained $2.3 billion in healthcare fraud recoveries and 2015 will be another significant year for False Claims Act enforcement - particularly as it relates to hospitals and associated providers.

Data Analytics is (Still) the Next Big Thing
By Steven Blumenthal | 02-06-2015
My not-so-bold prediction for 2015 is that it’ll be a busy year for the healthcare data analytics business. I admit that making 2015 predictions now is a little like placing a bet after the horses have run the first quarter mile...

CMS Flinches on Meaningful Use
By Angela Youngberg | 02-04-2015
Five years after the HITECH Act, the meaningful use incentive program for electronic health records (EHRs) is still confusing providers.

Key Takeaways from the Annual JP Morgan Conference
By Rob Harris | 02-02-2015
At the annual JP Morgan Healthcare Conference, we gained some key insights about the year ahead for the industry and what we can expect from investors and other key players.

EHRs, Data Integrity and the Critical Need for a Data Governance Plan
By Steven Blumenthal | 01-28-2015
The American Health Information Management Association (AHIMA) highlights the importance of data integrity, saying that trust plays a critical role in healthcare delivery and that trust depends on the completeness and correctness of data.

From Here to There: What It Will Take to Achieve the Goals of Population Health
By Andy Norwood | 01-16-2015
The primary goal of population health strategies is getting the different, more or less isolated, parts of healthcare ecosystem to come together into a loosely affiliated group. This is a not controversial idea.

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Waller’s healthcare blog brings together information on a variety of topics, including M&A trends, updates on new regulations, insights on government enforcement and investigations, tax, labor and employment, intellectual property and much more. Amid the uncertainties of healthcare reform and the realities of heightened regulatory enforcement, this blog is meant to serve as a resource to providers, payors, life science companies, healthcare IT firms, investors and others in the healthcare industry.
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