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Health Care


Healthcare fraud and abuse claims under the False Claims Act are on the rise, with the United States Department of Justice boasting that it recovered $2.5 billion in settlements and judgments in healthcare fraud investigations, prosecutions and civil litigations in 2016.
Memphis Special Counsel Shawn D. Sentilles authored "Implementing a Royalty Review Program: Safe Practices for Medical Device Manufacturers and Design Surgeons" for the Spring 2016 edition of Memphis Medical Society Quarterly.

Partner Jeffrey C. Smith with the Memphis office of Adams and Reese authored “Legal Briefs: Tennessee Supreme Court Reverses Course and Jettisons – Unworkable Summary Judgment Standard” appearing in the winter 2016 edition of The Memphis Medical Society Quarterly.

Special Counsel, Susan E. Mack with the Jacksonville office of Adams and Reese authored “Patrolling Cyberspace: Corporate Counsel's Role in Assuring Sufficiency of 'Business Associate' Agreements Under HIPAA” appearing in the 2015 4th Quarter Newsletter of the Association of Corporate Counsel (ACC) North Florida Chapter.
"Government Latin Lessons," The Memphis Medical Society Quarterly, authors: Adams and Reese attorneys Tim Gary and Alexandra Howard, Volume 18, Number 3, Fall 2015
According to the Occupational Health and Safety Administration (“OSHA”), 2013 statistics demonstrate that healthcare workers have a rate of work-related illness and injury that is nearly twice as high as the overall rate seen in private industry.
"Mid-Term Election Update: Physicians on Capitol Hill" - The Memphis Medical Society Quarterly, author: Mark Norris, Winter 2015
"CMS is Pumping the Brakes on its Recovery Audit Contractors," article by Adams and Reese attorney Hal B. (Wells) Johnson, The Memphis Medical Society Quarterly, Summer 2014
The House Health & Human Services Committee passed House Bill 7113 by Representative Jason Brodeur (R-Sanford) after adopting a strike all amendment that includes provisions on health care topics previously addressed in separate bills.
"Obama Administration Further Delays Employer Mandate" - Memphis Medical Society Quarterly, Spring 2014, author: Allison Jones, Adams and Reese heath care attorney, Jackson office
Over the years, the US Department of Labor Occupational Health and Safety Administration (“OSHA”) has focused attention on healthcare workers and the safety issues they face in a variety of ways. In 1999 OSHA proposed implementation of an “ergonomics standard,” intended to reduce musculoskeletal injuries for a host of different occupations, including healthcare workers.
"A Refresher Course on the Employer Mandate - It's Time to Get Ready!" - The Memphis Medical Society Quarterly, Winter 2014, author: Adams and Reese attorney Katie Gilchrist
In January, the Office for Civil Rights of the U.S. Department of Health & Human Services (HHS) published the final rules implementing the HITECH Act’s revisions to HIPAA. With a few exceptions, covered entities and business associates must adjust existing business practices in order to comply with these requirements by the September 23, 2013 compliance deadline. For most in the industry, maintaining the status quo will mean that compliance plans and policies will soon be outdated.
"Current Regulatory and Liability Issues for Drug Compounding" - DRI: For the Defense, authors: Adams and Reese attorneys Paige Sensenbrenner, Diana Surprenant and Laura Whitmore, September 2013.
The Patient Protection and Affordable Care Act (PPACA) launched various new regulations for employers regarding employee health insurance coverage. While the employer mandate to provide health coverage was postponed by one year, notice requirements still loom. The Fair Labor Standards Act (FLSA) requires employers to provide notice to employees of coverage options through the Health Insurance Marketplace that become available January 1, 2014.
"Affordable Care Act Effective Date Postponed" - Medical Society Quarterly, Fall 2013, author: Adams and Reese Partner Katie Gilchrist
"HIPAA Omnibus Rulemaking Expands Liability and Increases Costs of Compliance," Medical Society Quarterly, Spring 2013, Author: Adams and Reese attorney Brant Ryan
The Patient Protection and Affordable Care Act (PPACA) ushered in waves of new regulations for employers and health insurance issuers. Among them, is the requirement that insurers and plan sponsors provide a free “plain English” benefit summary called a “Summary of Benefits and Coverage” (SBC). The summaries are required to be provided to both enrollees and applicants for coverage.
In a 193 page long release, including four separate opinions, the United States Supreme Court largely upheld the entirety of the Patient Protection and Affordable Care Act (“ACA”).  Among other things the Act’s pertinent sections under the Court’s review included whether the individual mandate portion created a bar to prevent judicial consideration until 2014, and whether it was an unconstitutional exercise of Congressional power.
Accountable Care Organizations – The Final Rule by David Donnell. Winter Issue of Medical Society Quarterly
On May 12, on the floor of the Tennessee Senate, the Civil Justice Act of 2011 was debated for more than four hours making it the longest debate of a single bill in Tennessee history. What follows is the concluding “explanation of vote” filed by the prime sponsor, Senate Majority Leader Mark Norris, under Senate Rules after the debate summarizing his position on behalf of Governor Haslam.
"Answering The Call," Published in The Tennessee Volunteer Attorney Magazine, Tennessee Bar Association, Summer 2011 Edition, page 11. Author: Jeffrey Smith.
"New HIPAA Obligations for the Financial Industry," Law360 Health Care Section, Portfolio Media Inc., February 28, 2011, Author: David Donnell
In 2010 financial institutions were put squarely in the sights of privacy regulations historically found only in the health care industry.
For years the federal government has been cracking down on pharmaceutical companies, hospitals, device manufacturers and the like for complex schemes involving health care fraud.
The physician self-referral statute, otherwise known as the Stark law, prohibits referrals of Medicare and Medicaid patients for designated health services to entities with which the referring physician or his or her immediate family members have a financial relationship. Prior to the passage of the Patient Protection and Affordable Care Act (PPACA), there was no self-disclosure rule for Stark law violations. On September 23, 2010, pursuant to the requirement imposed by §6409 of PPACA, the Centers for Medicare & Medicaid Services (CMS) released the Medicare self-referral disclosure protocol (SRDP).
The Patient Protection and Affordable Care Act Immediately Impacts Providers' Compliance Requirements, written by Adams and Reese Partner Katie Gilchrist for the Memphis Medical Society Quarterly Summer 2010.
Last week the Office of Inspector General (the “OIG”) released an Advisory Opinion regarding whether imaging providers could perform pre-authorization services for patients being referred from other providers.
While we are all keenly aware of many of the changes the Patient Protection and Affordable Care Act (“PPACA”) will bring to the health insurance industry, employers of all sizes, and nearly all of us on an individual basis, the impact PPACA poses to the world of provider compliance issues has not been nearly so widely discussed.
Yesterday, in a vote of 56-43, the Senate passed the reconciliation bill (HR 4872) to health care overhaul that President Obama signed into law (PL 11-148) on Tuesday, March 23. The bill then went back to the House for final passage which resulted in a vote of 220-207.
Yesterday, the Congressional Budget (CBO) office released a preliminary review of the health care bill. The CBO estimates the cost of the new bill to be $940 billion over 10 years with a reduction in the deficit estimated to be $138 billion in the first 10 years and $1.2 trillion in the second 10 years. The House could vote on the Senate approved bill (HR 3590) as early as Sunday and if passed by the House, the bill would then be sent to the President for his signature.
Memphis Medical Society Quarterly article, Congressional Update: Affordable Health Care for America Act by Adams and Reese Partner Jeff Brooks.
Today, final text and scoring of the modified version of Health care Overhaul (HR 3590) is expected from the Congressional Budget Office (CBO). Modifications reflect the negations between the House, the Senate and the White House.
Adams and Reese Partner Jeff Brooks, who serves as the Practice Group Leader for the Special Business Services practice team and Partner in Charge of the Washington DC office, published an article, "Congressional Update: Affordable Health Care for America Act," in the Winter 2010 edition of Medical Society Quarterly.
In a vote of 60-39 Saturday night, the Senate invoked cloture on a motion to proceed with it’s version of health care overhaul, the Patient Protection and Affordable Care Act (HR 3590). Although seen by many as a victory for the future of America’s health care, upon return from the Thanksgiving recess, the Senate will promptly begin what is likely to be weeks of complicated debate.
On Wednesday, Senate leaders revealed their $849 billion proposal of health care over haul, projected by the Congressional Budget Office (CBO) to reduce the deficit by $127 billion over ten years. The Senate version comes within the President’s $900 billion proposed spending cap for health care and at $200 billion dollars less than the proposal from the House. It is estimated that 94% of Americans would have health insurance under the Senate’s proposal for health care overhaul.
Late on Saturday night,November 7, in a historical vote of 220-215, the House passed the Affordable Health Care for America Act (HR 3962) with 39 democrats voting “nay” and one Republican, Representative Joseph Cao, voting “yay”.
Late Saturday night, in a historical vote of 220-215, the House passed the Affordable Health Care for America Act (HR 3962) with thirty-nine democrats voting “nay” (please see the attached article for a list) and one Republican, Representative Joseph Cao, voting “yay”. Passage of the health care overhaul legislation was no easy task; it took months to come to an agreement on the final version introduced to the House and even on Saturday, it was not clear whether or not there would be enough votes to pass it.
Tuesday evening, House leadership released a 42-page package of amendments to their proposal for health care overhaul (HR 3962). From illegal immigration to the proposed market place exchanges, the proposed amendments cover a wide range of issues.
Yesterday, House leaders unveiled their version of a health care overhaul package, Affordable Health Care for America Act (HR 3962). The 1,900 page piece of legislation requires all American’s to have some type of health insurance coverage and is estimated to cost $900 billion over ten years. The legislation has yet to be scored by the Congressional Budget Office. Proposed financing of the House health care overhaul bill differs greatly from the Senate version; a key difference that is certain to be source of contention.
Yesterday, Finance Chairman Max Baucus introduced legislative language and a committee report for America’s Healthy Future Act (S 1796 – S Rept 111-89). Senate Majority Leader, Harry Reid continues to mediate negotiations for combining the Finance Committee and Health, Education, Labor and Pensions (HELP) Committee versions of health care overhaul today. The proposed date for introducing the combined version of the bills still remains tentatively set for October 26.
Yesterday, with a vote of 14-9, the Senate Finance committee approved it’s version of the health care overhaul bill. The bill, expected to cost $829 billion over ten years, is now in Senate Majority Leader Harry Reid’s office for negotiation of combining the Finance committee version with the Health, Education, Labor and Pensions (HELP) Committee version that was passed earlier this summer. The combined bill is expected to be on the Senate floor the week of October 26, but until then, Senator Reid will be the mediator resolving key differences between the two versions of health care overhaul.
Good news is always nice to deliver when the recipients are so many deserving Tennessee health care providers.
The Memphis Medical Society Quarterly Summer 2009 edition article by David W. Donnell "The Auditor Will See You Now."
Both the United States Department of Health and Human Services and the World Health Organization have made public declarations of the risk of pandemic due to the outbreak of swine influenza A (H1N1).
When your patients receive medical care, you should have a right to rely upon the insurance information they give you for payment.
The American Recovery and Reinvestment Act (also known as the “Stimulus Bill”) was signed into law by President Obama on February 17, 2009.
Health Care Law: Not Just About Medicine by Don S. McKinney, J.D., Ph.D, The Memphis Medical Society Quarterly
This is the third in a series of annual updates on legislative efforts to adopt medical liability reform.
On October 1, 2008, medical providers in Tennessee will have new protections against frivolous lawsuits.
A good physician-patient relationship is the cornerstone of success for any medical practice.
May a hospital enter into an arrangement to share cost savings with providers who adopt specific cost-saving surgical practices?
The 105th General Assembly convenes next month, and Medical Liability Reform will continue to loom large as one of the most pressing needs.
In 2005, the Tennessee Supreme Court grabbed the attention of physician group practices across Tennessee when it rendered its decision in the case of Murfreesboro Medical Clinic, P.A. v. David Udom.
Tennessee Supreme Court Rules Parent Corporation Liable for Interfering with Affiliate's Subsidiary Hospitals' Contracts by Jeffrey C. Smith and Lisa A. Moore, The Memphis Medical Society Quarterly, April 2007.