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Waller Healthcare Blog
Bundled Payments on the Back Burner
By Colin Luke | 03-22-2017
An interim final rule published by CMS has delayed the expansion of a number of bundled payment programs and initiatives.

Enforcement Trends: Five Lessons from Recent OCR Resolution Agreements and Other Enforcement Risks
By Beth Pitman | 03-06-2017
Since January, the OCR has entered into two Resolution Agreements for HIPAA violations, one Resolution Agreement for failure to timely report a breach, and one of only three Civil Money Penalties imposed for HIPAA violations since 2009.

Healthcare Providers Must Stay Current with State Legislative Developments
By Denise Burke, Jeff Parrish, Cati Lane Bailey | 03-02-2017
Developments in the Tennessee statehouse could have immediate impact on healthcare providers in the Volunteer State.

Proposed Rule from HHS Changes Standards for ACA Individual and Small Group Marketplaces
By Neil Krugman | 02-24-2017
HHS issues Proposed Rule in one of the Trump Administration's first concrete developments related to the Affordable Care Act.

Medical Necessity Claims Fail to Satisfy FCA Falsity Standard
By David Bridgers, Drew Warth, Wells Trompeter | 02-15-2017
A federal court dismissed a False Claims Act case alleging that surgical procedures performed by a cardiologist were medically unnecessary and subsequent Medicare and Medicaid reimbursement for the procedures amounted to false claims as a result.

Healthcare Industry on Pins and Needles: The Repeal of the ACA and What Comes Next
By J.D. Thomas | 01-19-2017
With the election of Donald Trump, and a Republican-controlled Congress, the repeal of the ACA is all but assured. It is not clear, however, what will come of the repeal of Obamacare and its replacement.

DOJ posts more big numbers with 2016 FCA recoveries
By J.D. Thomas, Richard Westling | 12-22-2016
For fiscal year 2016, the DOJ recovered $4.7 billion in settlements and judgments from civil cases involving the False Claims Act. More than half of the dollars recovered can be attributable to the healthcare industry.

HHS Continues to Face Pressure over Inability to Clear Administrative Appeals
By J.D. Thomas | 12-12-2016
Healthcare providers who have to deal with administrative audits and recoupment requests are well aware that attempts to contest or challenge them can result in protracted wait times.

OIG Authorizes Per-Dispense Fee for Vaccination Refrigeration Systems Located in Physician Offices
By Nora Liggett | 11-15-2016
The Department of Health and Human Services Office of the Inspector (OIG ) recently issued an advisory opinion that determined that a vaccine storage and dispensing system with a per-dispense fee did not violate the Anti-Kickback Statute.

Federal Court Grants Preliminary Injunction against CMS’ New Nursing Home Arbitration Rule
By Jeff Parrish | 11-09-2016
The U.S. District Court for the Northern District of Mississippi granted a preliminary injunction which likely provides at least temporary respite for long-term care facilities amidst a recent flurry of new regulation.

CMS Finalizes Policies on Site-Neutral Payments for Off-Campus Provider-Based Departments
By Patsy Powers | 11-08-2016
Changes to how off-campus provider-based departments are paid highlight 2017 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center Payment System Final Rule.

Anesthesiologists and the Enforcement of Non-Competes: Is Reform on the Way?
By Amanda Jester, Ashleigh VanLandingham | 10-25-2016
Non-competes are generally disfavored as a matter of law and public policy, and a recent White House report advocates non-compete reform at the state and federal level.

DOJ Sharpens Focus on Individual Wrongdoing with $1 Million Settlement and Four-Year Exclusion against Former CEO
By Kim Harvey Looney | 10-18-2016
On September 27, the DOJ, in conjunction with HHS-OIG, entered into a settlement agreement with former Tuomey Healthcare System CEO Ralph J. Cox III for alleged violations of the Stark Law.

What Clinicians Need to Know About 2017 Reporting under the New Medicare Quality Payment Program
By Beth Pitman | 10-17-2016
HHS has released the final rule outlining implementation of the MACRA Quality Payment Program which applies to clinicians or groups with more than $30,000 in Medicare Part B allowed charges and more than 100 Medicare patients.

HHS Imposes Steep Adjustment of Civil Monetary Penalties for Skilled Nursing Facilities and Home Health Agencies
By Jeff Parrish | 10-13-2016
Healthcare providers cited for violations of federal regulatory requirements – and particularly skilled nursing facilities and home health agencies – will face increased civil monetary penalties following recent publication of an interim final ru

CMS Bans Pre-Dispute Arbitration Agreements at Long-Term Care Facilities
By Jeff Parrish | 10-04-2016
CMS has issued a final rule that bans all pre-dispute arbitration agreements at long-term care facilities that participate in Medicare or Medicaid programs.

Tennessee Task Force Will Study the Role of APRNs
By Kim Harvey Looney | 09-22-2016
In an effort to confront healthcare access and cost concerns facing its residents, the State of Tennessee recently initiated a task force to examine an issue that many states are readdressing – the scope of practice for mid-level practitioners.

HHS Ramps Up Investigation of Small-Scale HIPAA Breaches
By Colbey Reagan | 09-20-2016
Following the settlement of a number of comparatively small patient privacy violations, HHS-OCR has directed its regional offices to take a more aggressive approach to breaches involving PHI of fewer than 500 individuals.

$2.95 Million Settlement May Mark Turning Point in Enforcement of the 60-Day Rule
By Patsy Powers, Alex Mills | 09-06-2016
A $2.95 million settlement represents one of the first settlements for the failure to return overpayments within the 60-day window since promulgation of the February 2016 final rule.

Recent Cases Offer Increased Prospects for Mergers by Competing Hospitals
By Beth Vessel | 07-19-2016
Recent setbacks experienced by the FTC in hospital merger challenges may embolden hospitals and health systems considering potential combinations.

Oncology Providers Beware: Possible Implications of CMS’ Proposed Rule on Off-Campus Provider-Based Departments
By Brent Bowman | 07-15-2016
Providers of oncology services should be aware of several provisions included in CMS' proposed rule intended to prohibit hospitals operating certain off-campus provider-based departments from billing under the Outpatient Prospective Payment System.

Many Questions Left Unanswered in the Wake of Long-awaited CMS Proposed Rule Regarding Off-Campus Provider-Based Departments
By Alex Mills | 07-11-2016
Many providers have serious concerns about CMS' proposal to prohibit hospitals operating certain off-campus provider-based departments from billing under the Outpatient Prospective Payment System.

More Belt-Tightening for Home Health Providers as CMS Proposes Update to Prospective Payment System
By Alex Mills | 06-30-2016
The home health industry could see its profit margins shrink further as a result of proposed updates to the Home Health Prospective Payment System released by the Centers for Medicare & Medicaid Services earlier this week.

Department of Labor “Persuader Rule” Put on Hold
By Mark Peters | 06-28-2016
Yesterday, a federal judge in Texas entered a nationwide injunction barring the Department of Labor from enforcing the "Persuader Rule."

Supreme Court Declines Case Challenging DOL Home Care Wage and Hour Rule
By Mark Peters | 06-28-2016
The United States Supreme Court declined yesterday to hear arguments in Home Care Association of America, et al. v. Weil, a case challenging the Department of Labor’s Final Rule that extended overtime and minimum wage protections to previously exem

The Supreme Court Upholds the Implied Certification Theory of Liability in False Claims Act Cases, Raises New Questions
By Richard Westling, J.D. Thomas | 06-17-2016
Yesterday, the Supreme Court issued a key decision that impacts the viability of the implied certification theory of liability in FCA cases.

Roundtable Discussion Provides Insights on State of Data Interoperability in Healthcare
By | 05-23-2016
Joined by healthcare IT companies, investors, providers and payors, Waller co-hosted a roundtable discussion on interoperability with Brentwood Capital Advisors. Participants discussed the barriers, opportunities and goals around interoperability.

HHS Issues Proposed Rule for MACRA Quality Payment Program
By Beth Pitman, Brandy Mann | 05-18-2016
Following up on the passage of the MACRA, HHS recently issued a proposed rule to replace the Medicare sustainable growth rate methodology which was repealed by MACRA.

International Trade Commission Rules Against Imported Dental Implants
By Matthew C. Cox | 05-10-2016
The U.S. International Trade Commission has concluded that certain dental implants infringe U.S. Patents and should be blocked from entry into the United States.

InfraGard Incident Response Briefing Focuses on Proactive Cybersecurity Efforts
By Steve Blumenthal | 04-28-2016
Waller hosts Middle Tennessee InfraGard Members Alliance’s Incident Response Briefing on increasing cybersecurity risks.

Guilt by Affiliation? Proposed Rule Would Expand CMS Program Integrity Authority
By Caitlyn Whitney, J.D. Thomas | 04-22-2016
Last month, CMS issued a proposed rule that would drastically expand the agency’s authority to further its program integrity efforts through the provider and supplier enrollment process.

Flurry of Activity Signals FTC’s Ongoing Interest in Healthcare Transactions
By Beth Vessel, Ashleigh VanLandingham | 04-21-2016
A number of events have occurred recently involving the Federal Trade Commission and healthcare entities.

CMS Says “the Future Is Now” with Comprehensive Primary Care Plus Announcement
By Denise Burke | 04-12-2016
The Centers for Medicare & Medicaid Services announced yesterday that it is launching a new initiative that “represents the future of health care.”

DOJ Announces Elder Justice Task Force Locations, Including Nashville and Middle Tennessee
By J.D. Thomas, Jeff Parrish | 04-11-2016
The Department of Justice announced a major new initiative to target quality of care and fraud and abuse in elder care by forming 10 Elder Justice Task Forces

Recent Developments in Hospice Fraud and Abuse
By J.D. Thomas | 04-06-2016
The past week has seen some interesting developments for hospice providers in the world of fraud and abuse.

OCR Announces Phase 2 HIPAA Audit Program
By Kevin Page | 03-25-2016
Under the 2016 Phase 2 HIPAA Audit Program, OCR will review policies and procedures adopted and employed by covered entities and business associates to comply with the applicable requirements of the HIPAA Privacy, Security & Breach Notification Rules

CMS Releases 2016 Value-Based Payment Modifier Program Results for Physicians
By Caitlyn Whitney | 03-22-2016
CMS released results for the Value-based Payment Modifier Program which provides for differential payment to physicians and physician groups under the Medicare Physician Fee Schedule.

Election Year Politics and Ongoing Transformation of Healthcare: A Recap of the LHC Delegation to D.C.
By J.D. Thomas, Morgan Ribeiro | 03-16-2016
In an election year, it’s easy to imagine D.C. being focused on the next President. Hearing from presenters at Leadership Health Care’s annual D.C. delegation, however, a lot is happening in our nation’s capital to advance healthcare.

CMS Commences Cycle 2 of the Medicare Provider and Supplier Revalidation Process
By Brandon Schirg, Casey Dunlap | 03-11-2016
On March 1, 2016, CMS announced the beginning of Cycle 2 of the revalidation process, which requires all Medicare providers and suppliers to resubmit and recertify the accuracy of their enrollment information on a regular and periodic basis.

Push for Interoperability Grows with a Series of Recent Announcements
By Steve Blumenthal | 03-07-2016
Last week, a pledge was announced at HIMSS by many of the industry’s vendors, providers and professional organizations to band together and push for interoperability. This follows similar announcements made by the federal government and agencies.

From Measuring “Clicks” to Measuring Performance
By Beth Pitman | 03-03-2016
CMS administrators Andy Slavitt and Karen DeSalvo have made numerous comments recently about the future of meaningful use and other government initiatives around data governance.

Speakers Address Key Issues for Long Term Care Providers at AHLA Event
By J.D. Thomas | 02-24-2016
Long term care providers and attorneys have come together this week at the AHLA Long Term Care and the Law summit. Speakers have provided insight on the regulatory landscape and emphasized the increasing importance of compliance.

Justice Department Enforcement Efforts Continue to Focus on Home Health
By Richard Westling | 02-22-2016
When trying to understand how the government chooses where to focus its efforts regarding healthcare fraud, it is a safe bet they will follow the money. Given this, the government's interest in home health services is not surprising.

Sixth Circuit Severely Narrows Available Damages Under the False Claims Act
By J.D. Thomas | 02-15-2016
The Sixth Circuit has once again narrowed the damages available to the government in FCA cases. While the immediate ramifications of this decision will be felt in the contracting fraud arena, it also has implications for healthcare fraud and abuse.

CMS Finalizes Rule Implementing the ACA’s 60-Day Report and Return Provision for Self-Identified Overpayments
By Richard Westling, Daniel Patten | 02-12-2016
CMS has published its final rule implementing the Affordable Care Act's 60-day report and return provision for self-identified overpayments. This publication offers much needed clarity for healthcare providers.

FTC Administrative Actions and Comments Indicate Shifting Landscape for Hospitals and Other Providers
By Beth Vessel, Ashleigh VanLandingham | 02-11-2016
Last year was a busy year for FTC as it continued to increase its focus on mergers involving healthcare providers.

FDA Takes On 2016’s Ubiquitous Issue: Cybersecurity
By Kristen Johns | 02-11-2016
Late last year, President Obama signed the Cybersecurity Act of 2015 into law, and more recently, the FDA issued a Draft Guidance regarding cybersecurity in medical devices.

Hospitals Celebrate Major Victory in Fight Related to RAC Appeals Backlog
By J.D. Thomas | 02-10-2016
The Court of Appeals for the D.C. Circuit yesterday reversed the lower court’s dismissal of a lawsuit seeking a writ of mandamus, a court order compelling HHS to work more quickly through the ever growing backlog of administrative appeals stemming

Bundled Payments: Are They Finally Here?
By Colin Luke | 02-09-2016
Healthcare providers are attempting to move toward population health. But without a mandate, progress to date has been slow. This will soon change with CMS' CCJR Model, which will go into effect on April 1, 2016.

DOL Final Rule Impacts Home Health “Companionship Services” Exemption
By Mark Peters | 02-01-2016
The DOL began enforcing its Final Rule extending overtime and minimum-wage protections to most home care workers previously deemed exempt in January. The home health industry has been busy looking for ways to minimize the impact of the DOL decision.

Supreme Court Evaluating Implied Certification in FCA Cases
By J.D. Thomas | 12-18-2015
On December 4th, the Supreme Court announced it would hear arguments in Universal Health Services, Inc. v. United States ex rel. Escobar, which will consider the viability of implied certification.

FTC Continues Focus on Healthcare Transactions with Penn State Hershey Merger
By Beth Vessel | 12-09-2015
Continuing its active review of healthcare transactions, on December 8, the FTC authorized an administrative action to block Penn State Hershey Medical Center’s proposed merger with PinnacleHealth System.

Hospitals Hit Hard in 2015 False Claims Act Enforcement
By J.D. Thomas | 12-08-2015
Last week, the DOJ announced another multi-billion dollar yearly haul from FCA enforcement -- totaling over $3.5 billion for FY 2015. Of that total, the majority came from the healthcare industry.

Supreme Court Weighs ERISA Preemption and Health Data Collection
By Sean Sullivan | 12-03-2015
U.S. Supreme Court heard oral arguments in a case that centers around a state law requiring health insurers to provide data on medical claims, pharmacy claims, member eligibility, etc.

Recruiting and Employing International Medical Graduates Post Medical Training
By Vinh Duong, Nora Katz | 12-01-2015
Today, approximately one in four physicians practicing in the United States obtained his or her medical education outside the U.S. Despite this fact, some hospitals and health systems are reluctant to recruit and hire international medical graduates.

Deputy Attorney General Yates Elaborates on Individual Accountability for Corporate Wrongdoing
By Richard Westling | 11-16-2015
Deputy Attorney General Sally Quillian Yates' remarks on the "Yates Memorandum" should be of interest to companies in the healthcare industry.

Recent FTC Administrative Decisions and Comments Indicate Shifting Landscape For Hospitals
By Beth Vessel | 11-13-2015
In the latest example of their involvement in hospital transactions, the FTC filed an administrative complaint last week regarding a WV deal.

Clinical Co-Management Agreements Offer Opportunity for Physician Alignment
By Colin Luke | 11-11-2015
Clinical co-management agreements offer an opportunity to align the interests of hospitals and practicing physicians in order to achieve better clinical outcomes and patient satisfaction.

Doctors and Hospitals Face Cuts in the Proposed Budget Deal
By Brandon Schirg, Michael Staley | 10-30-2015
The House and Senate have passed a two-year $80 billion budget deal, which would limit future payment rates for hospitals that set up or buy off-campus facilities.

Real Estate as a Tool for Improving Physician Alignment
By Jeffrey A. Calk | 10-27-2015
Today, every hospital and health system is looking for strategic opportunities to improve its alignment with physicians. These efforts often involve the acquisition of physician practices, employment of physicians and strategic joint ventures.

Community Health Needs Assessments and Implementation: The Board’s Ongoing Responsibility
By Don Stuart | 10-13-2015
Many healthcare boards believe they have satisfied the 501(r) CHNA requirements by completing their organization’s CHNA report and adopting an implementation strategy but that's only the beginning.

Relief for 2015 Meaningful Use Reporting but Stage 3 Final Rule Future is Uncertain
By Beth Pitman | 10-09-2015
Earlier this week, after considering more than 2,500 comments, CMS released the much anticipated Final Rule for EHR Incentive Program - Stage 3 and Modifications to Meaningful Use in 2015 and 2017.

OIG Takes Aim at Skilled Nursing Therapy Billing
By Jeff Parrish | 10-08-2015
The Department of Health and Human Services’ Office of Inspector General issued a report, “The Medicare Payment System for Skilled Nursing Facilities Needs To Be Reevaluated,” in which the OIG was very critical of SNF therapy billing.

Thoughts from the 2015 AHLA Fraud and Compliance Forum
By J.D. Thomas, Meredith Toole | 10-01-2015
Once again, AHLA outdid itself and put on an excellent program at the 2015 Fraud and Compliance Forum. The program combined a unique mix of speakers from government, in-house legal and compliance personnel and outside counsel with timely and interest

OIG Recommends Strengthening OCR Oversight of HIPAA Privacy and Breach Follow-up
By Beth Pitman | 10-01-2015
The Office of Inspector General (OIG) recently released two reports recommending that the Office of Civil Rights (OCR) strengthen (1) its oversight of covered entity compliance with HIPAA privacy standards, and (2) its follow-up of reported breaches

Healthcare Data Analytics Patent Subject to “CBM” Review at USPTO
By Matthew C. Cox, Charlie Walker | 09-29-2015
On September 10, 2015 in the case Symphony Health Solutions Corp. v. IMS Health Inc., (CBM2015-00085) the U.S. Patent Trial and Appeal Board (“PTAB”) granted institution of a Covered Business Method (CBM) review under the Leahy-Smith America Inve

AHLA’s Fraud and Compliance Forum Kicks Off with Keynote Speech from Joyce Branda, Deputy Assistant Attorney General
By J.D. Thomas, Meredith Toole | 09-28-2015
Deputy Assistant AG Joyce Branda provided an update on the DOJ's enforcement and litigation of the False Claims Act at the AHLA's annual Fraud and Compliance Forum.

Extension of Public Comment Period Speaks to Impact of NIST’s Healthcare-Focused Cybersecurity Guide
By Julian Bibb, Kristen Johns | 09-28-2015
The NCCOE has recently extended the comment period its recent guide, which serves as one of the most comprehensive manuals to address the protection of patient information records, with a particular focus on securing mobile technology.

Stark Settlement Dominoes Beginning to Fall in the Aftermath of Tuomey
By J.D. Thomas | 09-23-2015
In the last two weeks the practical effects of Tuomey have become clear with the Department of Justice announcing two record-breaking False Claims Act settlements related to Stark Law violations.

HRSA: At long last, "mega-guidance" on 340B program
By John Arnold | 09-15-2015
The long-awaited “mega-guidance” recently proposed by HRSA attempts to clarify several important aspects of the 340B Drug Pricing Program.

Zero to Sixty: The Overpayments Clock Is Ticking and the Courts Are Keeping Time
By J.D. Thomas, Jennifer Weaver | 09-14-2015
The healthcare industry recently saw the first reported court opinion in a False Claims Act case involving the 60-day rule for overpayments.

Meaningful Use Rules Under Review by the OMB
By Beth Pitman | 09-10-2015
CMS sent the long-awaited final rule that modifies the requirements of the Meaningful Use program Stages 1 and 2, as well as the rule implementing Stage 3, to the OMB.

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.