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Showing 10 posts in Health Care Provider.

Attention Health Care Providers: California Adopts Restricted Knox-Keene Licensure/Exemption Requirements

The California Department of Managed Health Care (the "DMHC"), which regulates Health Care Service Plans, recently adopted a regulation regarding general licensure requirements for health care providers ("Entities") that accept global risk, as defined by the Knox-Keene Health Care Service Plan Act of 1975 ("Knox-Keene Act"). Taking effect this week (July 1, 2019), the regulation is codified in California Code of Regulations, title 28, section 1300.49.

The new law will require most Entities to file their health plan contracts and request an exemption any time they enter into or renew a health plan contract during the next 12 months, and will eventually require a significant minority of the approximately 300 Entities in California to obtain licensure as a Knox-Keene Plan. Below, we take a closer look at these requirements and how they will impact the Entities. More ›

Health Care Providers and Pharmaceutical Distributors Should Heed These Warnings to Reduce the Risk of an Opioid-Related Lawsuit

The national opioid crisis has triggered an avalanche of lawsuits around the country. Pharmaceutical manufacturers and distributors are often among the named defendants, but other entities are also at risk. The wide variety of claims that figure in these lawsuits means that all health care industry participants should evaluate their risk of being subjected to an opiate-related claim. Many of these suits are being consolidated into multidistrict litigation (MDL), while others are being handled as individual claims. More ›

What Health Care Providers Need to Know About the Illinois Gender Violence Act

Years before the rise of the "#MeToo" movement, the Illinois Gender Violence Act (IGVA) was enacted to give victims of criminal "gender violence" a civil remedy. The IGVA creates a civil cause of action for persons who have been subjected to gender-related violence, which is defined in part as, "a physical intrusion or physical invasion of a sexual nature under coercive conditions satisfying the elements of battery under the laws of Illinois." A cause of action under the IGVA exists regardless of whether the alleged act of sexual aggression resulted in criminal charges, prosecution, or conviction. Essentially, any claim involving sexual harassment and physical touching could arguably fall within the scope of the statute. More ›

Sixth Circuit Applies Escobar Ruling in Decision to Resuscitate False Claims Act Case

The United States Court of Appeals for the Sixth Circuit recently resuscitated a qui tam action under the False Claims Act (FCA), and, in so doing, held that the relator had properly alleged materiality under the U.S. Supreme Court's decision in Universal Health Services Inc. v. United States ex rel. Escobar, 136 S. Ct. 1989, 2002 (2016). The Sixth Circuit's decision, U.S. ex rel. Prather v. Brookdale Senior Living Communities, Inc., 892 F.3d 22 (6th Cir. June 11, 2018) addressed a relator's claims under the FCA. The FCA imposes civil liability on those who defraud the federal government by levying fines and penalties, including up to three times the government's damages. Private persons called relators file lawsuits or qui tam actions for violations of the FCA on behalf of the government. More ›

More than 600 Healthcare Professionals Hit by DOJ with Medicare Fraud Charges

The number of criminal charges filed annually by the Department of Justice (DOJ) against health care providers and professionals continues to escalate. On June 28, 2018, the DOJ announced that the Medicare Fraud Strike Force had charged 601 individuals across the United States, including more than 150 physicians, nurses, and other licensed medical professionals for participating in health care fraud schemes involving more than $2 billion in false billings this summer. At the same time, the U.S. Department of Health and Human Services initiated suspension actions against numerous providers, including doctors, nurses, and pharmacists. More ›

Common Mistakes Physician Extenders Make in Their Practices

First of all, for those who may be thinking “what is a physician extender,” a physician extender is a licensed health care provider (not a physician) that provides medical services typically performed by a physician. More ›

EMR and E-Discovery Part Five: On Standard of Care and Final Thoughts

In the final installment of our series, EMR and E-Discovery, author David Levitt discusses the need for healthcare institutions to develop a management strategy for patient care communications and its impact on standard of care. More ›

411 on Telehealth

The world of health care delivery is quickly evolving to meet both personalized consumer demand and the need for cost-efficient, quality outcomes. More ›

Healthcare Providers Beware: Medicare Billing Can Be Risky Business

When a health care provider or third party billing service submits a claim for services rendered to a Medicare patient, it’s filing a bill with the government that certifies the payment was earned and complies with certain billing requirements. More ›

EMR and E-Discovery Part Three: All Systems Go

In part three of our series, EMR and E-Discovery, author David Levitt details the current diagnostic tools utilized by modern health care as well as some of the considerations healthcare institutions should evaluate when making decisions about software and licensing. More ›

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