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Healthcare Authority Newsletter - June 2023 #2

News Briefs - High Court Rules Residents Can Sue Publicly Owned Nursing Homes - The U.S. Supreme Court preserved the ability of people to sue for civil rights violations under an 1871 law as it rejected a bid to prevent an...more

Healthcare Authority Newsletter - June 2023 #1

News Briefs - Debt Limit Deal Will Claw Back $27.1B in Unspent COVID Funding - President Joe Biden signed a debt limit deal that includes some minimal cuts for healthcare programs just days before the federal government was...more

SCOTUS Rejects Objective Knowledge Standard in False Claims Act; Defendant’s Subjective Belief Is Key to Scienter

In a unanimous opinion issued on June 1, 2023, the Supreme Court of the United States clarified the relevant standard for scienter — or knowledge — in False Claims Act (“FCA”) actions by ruling that an objectively reasonable...more

Healthcare Authority Newsletter - May 2023 #5

News Briefs - Inflation Causes Many Patients to Skip Doctors' Appointments - As prices go up generally, patients stay away from their physicians, according to federal analysts. In 2022, 28 percent of adults went without some...more

Healthcare Authority Newsletter - May 2023 #4

News Briefs - WHO Warns Rapid Adoption of AI in Healthcare Could Be Dangerous - The World Health Organization is warning that the "meteoric" rise of artificial intelligence tools in healthcare threatens the safety of patients...more

Healthcare Authority Newsletter - May 2023 #3

News Briefs - PHE End Brings Challenges for Nursing Home Operators - As the public health emergency (PHE) came to an end on May 11, industry leaders point out that nursing home operators are still in pandemic recovery mode...more

Healthcare Authority Newsletter - May 2023 #2

News Briefs - DEA Seeks to Extend Virtual Prescribing Flexibility as PHE Ends - After receiving thousands of comments asking for an extension of pandemic-era virtual prescribing flexibilities, the Drug Enforcement...more

Healthcare Authority Newsletter - May 2023 #1

News Briefs - CMS Enforces Hospital Price Transparency Rule with Fines CMS is cracking down on hospital price transparency compliance -- or lack thereof. The federal agency announced updated enforcement procedures, including...more

Sixth Circuit Affirms Dismissal of Anti-Kickback Statute-Based False Claims Act Complaint

The United States Court of Appeals for the Sixth Circuit recently affirmed an order dismissing a qui tam False Claims Act (“FCA”) suit based on alleged violations of the Anti-Kickback Statute (“AKS”). The appeals court agreed...more

Federal Court Rejects Bid to Declare Co-Pay Assistance Program Lawful

The United States District Court for the Southern District of New York recently rejected Pfizer’s request for a declaration that its co-pay program would not violate the Anti-Kickback Statute (“AKS”). The case is Pfizer Inc....more

AGG Food & Drug Newsletter - November 2021

Arnall Golden Gregory LLP's Food & Drug Newsletter is a monthly update of legal and regulatory issues that affect the FDA-regulated community and highlights articles from members of our Food & Drug practice, as well as from...more

Georgia Supreme Court Sides With Nursing Home on Arbitration Issue Briefed by AGG Attorneys

Since 1925, Congress and the United States Supreme Court have recognized arbitration as a favored means of dispute resolution, offering a faster, more private, and less expensive alternative to the court systems....more

AGG Food & Drug Newsletter - May 2021

Arnall Golden Gregory LLP's Food & Drug Newsletter is a monthly update of legal and regulatory issues that affect the FDA-regulated community and highlights articles from members of our Food & Drug practice, as well as from...more

Ninth Circuit Rules False Claims Act Suit Involving Off-Label Use of Medical Devices

The United States Court of Appeals for the Ninth Circuit recently considered an Order of the Central District of California dismissing a qui tam False Claims Act (FCA) suit against a medical device manufacturer based on...more

OIG to Audit Telehealth Services Provided During Pandemic by Part B and Home Health Providers

The U.S. Department of Health and Human Services (HHS), Office of Inspector General (OIG) recently updated its 2021 Work Plan in January to include audits of Medicare Part B and home health telehealth services by OIG’s Office...more

11th Circuit Confines Anti-Kickback Statute’s “One Purpose” Rule

On November 24, 2020, the Eleventh Circuit issued an opinion in U.S. v Shah (Case No. 19-12319), in which it disposed of the Anti-Kickback Statute’s (AKS or the “statute”) “one purpose” rule in certain circumstances. In this...more

OIG Weighs-In on the Review of Extrapolated Overpayments in the Medicare Appeals Process

The financial stakes are often very high for providers when statistical sampling and extrapolation is used to calculate an alleged Medicare overpayment. In post-payment audits involving extrapolation, an actual claims denial...more

9/9/2020  /  Appeals , Extrapolation , MACs , Medicare , OIG , Overpayment , QICs

Georgia Supreme Court Sides with Hospitals in Lien Battle

Drawing to a close a protracted battle over Georgia’s hospital lien statute, the Georgia Supreme Court issued an opinion on June 29, 2020, siding with Georgia’s hospital community. The class action case involved allegations...more

AGG Helps Providers Obtain Reimbursement of Bad Debts

Between 2006 and 2014, affiliated long-term care hospitals and a skilled nursing facility (“the Providers”) provided covered services to patients who were eligible for both Medicare and Medicaid (“dual-eligible...more

AGG Hospice Quarterly 2020

CMS Announces Hospice Capitation Rates for Medicare Advantage - The U.S. Centers for Medicare and Medicaid Services (CMS) recently released the capitation rates for hospice care through the value-based insurance design...more

2020 Healthcare Authority: January 2020 #3

Investor Interest in Health IT Expected to Remain Strong in 2020 - After three years of strong growth in healthcare technology funding, investor interest in the space has not abated....more

Nursing Facilities Obtain Increase of Fair Rental Value Rates

During 2018, five nursing facilities sought to create a more livable space for their residents by reducing their licensed bed capacities. These changes eliminated 3-bed wards in favor of semi-private rooms and improved living...more

2020 Healthcare Authority: January 2020 #2

Digital Health Companies Look Toward IPOs as M&A Stabilizes - Digital health funding in 2019 suggests more companies will be looking to go public or be acquired in the coming years, according to a report from seed fund and...more

2020 Healthcare Authority: January 2020 #1

News Briefs - FDA Exempts Some Medical Devices from Premarket Review - FDA closed out the year with the publication of a final order that exempts dozens of Class I and Class II medical devices from 510(k) premarket...more

Georgia Supreme Court Amends Rules Regarding Amicus Briefs

The decisions of appellate courts often establish precedent that will have ramifications that extend far beyond the immediate parties to an appeal. ...more

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