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Health Law Informer Blog

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CMS Issues Final Rule Impacting Prior Authorization Process

USA - January 24 2024 Last week CMS issued its final rule “CMS Interoperability and Prior Authorization” (CMS-0057-F), unchanged from its proposed rule in 2022, which…

New York May Be Paving the Way for State-level Cybersecurity Regulations on Health Care Facilities

USA - November 28 2023 Last month, a cyberattack forced two New York hospitals to divert and even discharge some patients to other facilities, while the affected hospitals…

Provider Charged with Receiving and Paying Millions in Kickbacks in Connection with Sober Homes

USA - September 22 2023 On Friday, September 15th, the United States Attorney’s Office for the District of Massachusetts (United States) and the Massachusetts Attorney…

UnitedHealthcare’s Changing Approach to Prior Authorizations

USA - July 13 2023 Prior authorizations, one of health insurers’ many “utilization management” techniques, is a hot topic amongst practicing physicians, patients, and…

HHS Proposes $9 Billion Lump Sum Payment for Hospitals to Remedy Unlawful 340B Payment Reductions

USA - July 10 2023 On Friday, July 7, 2023, the Centers for Medicare & Medicaid Services (CMS) published their long-awaited proposed remedy to the unlawful 340B drug…

Will The Standard of Liability Under The 60-Day Repayment Rule Change?

USA - February 21 2023 At the end of last year, the Centers for Medicare & Medicaid Services (CMS) proposed changes to the so-called 60-day repayment rule. The proposed…

New Protections for Employees of Certain New Jersey Health Care Entities

USA - October 27 2022 Health care entities, home health care agencies, and staffing registries considering a transaction in New Jersey will need to keep in mind new…

En Banc Fourth Circuit Affirms Dismissal of False Claims Act Lawsuit and Vacates Panel Opinion

USA - October 14 2022 We previously reported that the Fourth Circuit, via a 2-1 decision in United States ex rel. Sheldon v. Allergan Sales, LLC, 24 F.4th 340 (4th Cir…

Industry Interactions with Physicians Continue to be a Hot Topic for Civil False Claims Act Enforcement Actions under Private Qui Tam Litigation

USA - October 6 2022 In a continuing wave of fraud and abuse civil enforcement actions brought by qui tam relators, big pharma giant, Biogen, is the latest corporate…

HIPAA “Right of Access” Enforcement Trend Continues

USA - September 27 2022 The Office of Civil Rights of the Department of Health and Human Services (“OCR”) announced the resolution of three more right of access cases…