Insights on Health Care

The US Attorney General announced a “takedown” of 243 defendants over the last three days, representing the largest health care fraud enforcement effort in the Medicare Fraud Strike Force’s eight-year history and the largest criminal health care fraud action in the history of the Justice Department.

On June 17, 2015, the Health Resources and Services Administration (HRSA) published a long-awaited proposed rule setting forth revisions to the current regulations governing the 340B Drug Discount Program (340B Program) as set forth in 42 C.F.R. part 10 (Proposed Rule).

The Department of Health and Human Services Office of the Inspector General issued a Fraud Alert, reminding physicians that they will be held liable under the anti-kickback statute for compensation arrangements that do not reflect fair market value compensation for bona fide services they provide.

Charitable organizations that want to provide financial assistance to patients for the costs of health care are challenged with ensuring that their programs do not run afoul of federal fraud and abuse laws.

The 2015 edition of Legal 500 US has rated 50 Arent Fox LLP attorneys as national leaders in their field. In addition, 15 of the firm’s practice areas were ranked among the best in the country.

The United States Department of Justice (DOJ) announced that pharmacy benefits manager Medco Health Solutions Inc. (Medco) agreed to pay the government $7.9 million to resolve allegations that Medco’s arrangements with pharmaceutical manufacturer AstraZeneca violated the False Claim Act.

Partner Linda Baumann was quoted extensively in Bloomberg BNA’s Health Law Resource Center’s article on the landmark False Claims Act case decided by the Supreme Court on May 26, 2015, Kellogg Brown & Root Svcs., Inc. v. United States ex rel. Carter.

The US Supreme Court on Tuesday decided a closely watched False Claims Act (FCA) case, Kellogg Brown & Root Services, Inc. v. United States ex rel. Carter, with important implications for companies confronting FCA claims.

Pharmaceutical manufacturers could face a new line of attack related to Hatch-Waxman reverse payment settlement agreements (so-called, “pay-for-delay” settlements).

The Chairman of the U.S. Senate Committee on Health, Education, Labor, and Pensions recently started an investigation into whether agency “guidance” is being used as a means to impose obligations on the public while circumventing the formal rule making process. 

Health care lawyers are familiar with the term “underground rulemaking,” which refers to efforts by federal agencies to impose obligations on providers and suppliers informally, without using the processes required by law. That issue has recently attracted the attention of the US Senate. 

Linda A. Baumann was quoted extensively by Bloomberg BNA’s Health Care Fraud Report in a story following a speech by the Assistant Attorney General for the Justice Department’s Criminal Division, Leslie Caldwell, on new developments in DOJ’s handling and resolution of certain investigations.

Arent Fox LLP is proud to announce that, for the thirteenth year in a row, Health Care partner Linda A. Baumann served as editor-in-chief of a comprehensive desk reference focused on fraud and abuse for lawyers in the health care industry.

Arent Fox LLP is proud to announce the publication of a comprehensive and definitive book for health care industry leaders focused on risk management and litigation.

An Arent Fox team led by noted commercial litigator Hunter T. Carter prevailed at the US Court of Appeals for the Second Circuit.

The US Department of Health and Human Services Office of Inspector General, the Association of Healthcare Internal Auditors, the American Health Lawyers Association, and the Health Care Compliance Association jointly released an educational resource for governing boards.

Last week, Health Care partner Lowell C. Brown published an article in Bloomberg BNA’s Health Law Report that examines what hospital and medical staff leaders should do when a staff member is hospitalized with signs of impairment.

Peter R. Zeidenberg and Health Care partner David S. Greenberg published an article in Bloomberg BNA’s Health Care Fraud Report that examines an important decision after the Department of Justice (DOJ) successfully prosecuted Medicare fraud at Sacred Heart Hospital in Chicago.

On March 31, 2015, the Supreme Court of the United States issued a 5-4 decision in the case of Armstrong v. Exceptional Child Center, Inc., 575 U.S. __ (2015), holding that health care providers do not have the right to sue a state Medicaid program under Section 30(A) of the federal Medicaid Act (Se

This change in policy also could make a tremendous difference to provider operations since it would allow them to have access to certain funds during the very lengthy period while they wait for the ALJ determination.

California’s 4th District Court of Appeal issued its opinion in Gerard v. Orange Coast Memorial Medical Center, invalidating the portion of California IWC Wage Order No. 5 that permitted non-exempt health care employees to waive a second meal period for shifts longer than 12 hours.

Arent Fox partner Lowell C. Brown, head of the firm’s Health Care practice, was quoted in a recent Bloomberg BNA article following a novel and groundbreaking decision by the New Mexico Supreme Court.

When the Bylaws specifically and directly speak, for example, in matters of credentialing criteria, peer review processes, and Medical Staff hearing procedures, the pronouncements are not viewed as suggestions or hints. Rather, the Medical Staff Bylaws set forth requirements.

On February 10, 2015, in this most recent win for the federal enforcement agency, the US Court of Appeals for the Ninth Circuit affirmed the FTC’s injunction against St. Luke’s Health System and a large physician group in Idaho.

In a meeting with almost two dozen health care leaders on January 26, 2015, Health and Human Services (HHS) Secretary Sylvia M. Burwell outlined the clear goals and timelines for moving the Medicare program towards quality-based payments, from quantity or fee-for-service payment models.