Over the last two years, behavioral health (BH) has been one of the biggest growth areas in the health care ecosystem, fueled by the Public Health Emergency (PHE) but in many ways an ignored, overlooked, understaffed, and...more
4/1/2022
/ CMMI ,
Consolidated Appropriations Act (CAA) ,
DEA ,
Department of Health and Human Services (HHS) ,
Department of Labor (DOL) ,
Health Care Providers ,
Investors ,
Medicaid ,
Mental Health ,
Mental Health Parity Rule ,
MHPAEA ,
NQTLs ,
Out of Network Provider ,
Public Health Emergency ,
Reimbursements ,
Substance Abuse ,
Surprise Medical Bills
Hosted by the Health Plan Alliance, I was joined by Ken Barrette, Managing Director of Health Care at Alvarez and Marsal, and Marshall Votta, Operating Partner at Nautic Partners, to discuss the unique opportunities that...more
California Senate Bill 977 (SB-977), entitled “Health care system consolidation: Attorney General approval and enforcement,” is set for a June 9 hearing before the Senate Appropriations Committee. The bill has two main...more
Between various blanket Section 1135 waivers and state specific waivers issued by CMS, provisions of the Coronavirus Aid, Relief, and Economic Security Act (the CARES Act) and numerous state, local and accreditation body...more
The Senior Housing Industry has been uniquely impacted by the coronavirus pandemic. In addition to the various logistical, practical, and educational measures senior housing communities should be taking to monitor, respond to...more
4/10/2020
/ Ambulatory Surgery Centers ,
Assisted Living Facilities (ALFs) ,
Certificate of Need ,
Dedicated Emergency Departments ,
Federal Funding ,
Health Care Providers ,
Healthcare Facilities ,
Healthcare Reform ,
Hospitals ,
Inpatient Rehab Facilities ,
Legislative Agendas ,
Long Term Care Facilities ,
Proposed Legislation ,
Regulatory Agenda ,
Reviewability Determinations
The United States Court of Appeals for the Third Circuit ruled last week that whistleblower relators need not show “objective falsity” to prove their claims, and that a dispute among physician experts about a clinical...more
3/12/2020
/ False Claims Act (FCA) ,
Health Care Providers ,
Hospice ,
Insurance Fraud ,
Life Sciences ,
Medicare ,
Objective Falsity ,
Physicians ,
Professional Liability ,
Qui Tam ,
Relators ,
Scienter ,
Triable Issue of Fact ,
Whistleblowers
Federal enforcers typically announce (formally as well as informally) work plans or focus areas for the upcoming year that can provide some guidance as to where providers might anticipate enforcement action and, where they...more
All hospice providers routinely should assess risk exposure under the False Claims Act — now with the benefit of the U.S. Court of Appeals for the Eleventh Circuit’s long-awaited decision in United States v. AseraCare Inc. ...more
2/4/2020
/ Appeals ,
Evidence ,
False Claims Act (FCA) ,
Health Care Providers ,
Hospice ,
Jury Verdicts ,
Medical Experts ,
Medical Records ,
Medicare ,
Objective Falsity ,
Physicians ,
Summary Judgment ,
Terminal Illness Treatments ,
Trial Court Orders ,
Vacated
Despite the pressure and turmoil going on in certain sectors of the health care continuum, both home health and hospice continue to shine as attractive investment and expansion opportunities for existing providers. Each...more
Big changes were announced this past week in what Health and Human Services (HHS) has labeled a “Regulatory Sprint to Coordinated Care.” Foley will be breaking down many of the areas of the proposed rule and the effects on...more
Welcome to Foley & Lardner LLP’s Health Care MarketTrends. In this issue, we examine private equity investment in specialty areas of the health care industry, specifically dermatology and orthopedics....more
9/17/2019
/ Anti-Kickback Statute ,
Audits ,
Billing ,
Centers for Medicare & Medicaid Services (CMS) ,
Coding ,
Health Care Providers ,
Hospitals ,
Investors ,
Medicaid ,
Medicare ,
Private Equity ,
Private Equity Firms ,
Specialty Healthcare ,
Stark Law
Tuesday’s ruling by the United States Court of Appeals for the Eleventh Circuit in United States v. AseraCare is a win for hospice and other health care providers who have long argued that a mere difference of clinical...more
How Oncology Can Benefit from Digital Technology -
Welcome to Foley’s new health care MarketTrends newsletter. Each edition, we will focus on a different aspect of health care and highlight key trends in the industry. In...more
A new wave of change is poised to disrupt the way health care is delivered in the United States. This time around, the disruption is coming not from lawmakers or the president, who have struggled to repeal or improve upon...more
1/30/2019
/ Affordable Care Act ,
Artificial Intelligence ,
Centers for Medicare & Medicaid Services (CMS) ,
Cybersecurity ,
Department of Veterans Affairs ,
Drug Pricing ,
Health Care Providers ,
Healthcare ,
Healthcare Reform ,
Internet of Things ,
Legislative Agendas ,
Medicaid ,
Medicare Advantage ,
Popular ,
Request For Information ,
Stark Law ,
Telehealth
As telemedicine continues to see significant traction, health care organizations are working to implement telemedicine programs and create technology infrastructures all while working within the current legislative...more
Providers and suppliers who have been assessed overpayments for Medicare services are entitled, by statute, to a stay of recoupment while the provider or supplier’s appeal is pending – but only at the first two levels of...more
7/19/2018
/ Administrative Appeals ,
Administrative Law Judge (ALJ) ,
Centers for Medicare & Medicaid Services (CMS) ,
Due Process ,
Health Care Providers ,
Medicare ,
Medicare Provider Agreements ,
Overpayment ,
Physician Medicare Reimbursements ,
Recoupment ,
ZPIC
At the 11th Annual Investment and M&A Opportunities in Healthcare conference in Nashville on June 6th, 2018, a panel session moderated by Chris Donovan, partner in Foley’s Health Care Practice Group, addressed the topic of...more
Despite some initial difficulty in gaining momentum, the use of value-based payment methodologies will likely increase across all provider niches. This change is partly a function of cost savings driven by margin compression...more
In early December, leading experts in digital health and telemedicine came together at the Digital Health Care Investors Summit hosted by Foley & Lardner LLP and Deloitte. The Summit explored innovations in digital health...more
A distinguished panel of providers, consultants and IT firms convened on Tuesday, June 21st in New York at the Foley and Lardner LLP offices to share a discussion focused on the convergence of IT spend and new value based...more
Whether in an auction or proprietary transaction, risk allocation has typically been a function of indemnities tied to reps and warranties and the type of credit supporting the type of supporting credit. Holdbacks, earnouts,...more
7/16/2015
/ Asset Deals ,
Auction ,
Buyers ,
Exit Strategies ,
Health Care Providers ,
Healthcare ,
Indemnification ,
Medicaid ,
Medicare ,
Private Equity ,
Recoupment ,
Risk Allocation ,
Risk Management ,
Sellers ,
Stark Law ,
Underwriting ,
Warranty Insurance
The juncture of the increasing drive to lower health care costs, consumer preferences for at home care or care in more residential environments, and the ability to deliver care as needed in portable and flexible ways, all...more
Solutions and opportunities may be on the horizon for post-acute providers (“PAPs”) and hospitals participating (or thinking of participating) in ACOs that have reservations about taking on additional downside cost risk...more