Waller Healthcare Blog
Medical Necessity Claims Fail to Satisfy FCA Falsity StandardBy David Bridgers, Drew Warth, Wells Trompeter | 02-15-2017
A federal court dismissed a False Claims Act case alleging that surgical procedures performed by a cardiologist were medically unnecessary and subsequent Medicare and Medicaid reimbursement for the procedures amounted to false claims as a result.
DOJ posts more big numbers with 2016 FCA recoveriesBy J.D. Thomas, Richard Westling | 12-22-2016
For fiscal year 2016, the DOJ recovered $4.7 billion in settlements and judgments from civil cases involving the False Claims Act. More than half of the dollars recovered can be attributable to the healthcare industry.
Tennessee Task Force Will Study the Role of APRNsBy Kim Harvey Looney | 09-22-2016
In an effort to confront healthcare access and cost concerns facing its residents, the State of Tennessee recently initiated a task force to examine an issue that many states are readdressing – the scope of practice for mid-level practitioners.
HHS Ramps Up Investigation of Small-Scale HIPAA Breaches By Colbey Reagan | 09-20-2016
Following the settlement of a number of comparatively small patient privacy violations, HHS-OCR has directed its regional offices to take a more aggressive approach to breaches involving PHI of fewer than 500 individuals.
OCR Announces Phase 2 HIPAA Audit ProgramBy Kevin Page | 03-25-2016
Under the 2016 Phase 2 HIPAA Audit Program, OCR will review policies and procedures adopted and employed by covered entities and business associates to comply with the applicable requirements of the HIPAA Privacy, Security & Breach Notification Rules
Push for Interoperability Grows with a Series of Recent AnnouncementsBy Steve Blumenthal | 03-07-2016
Last week, a pledge was announced at HIMSS by many of the industry’s vendors, providers and professional organizations to band together and push for interoperability. This follows similar announcements made by the federal government and agencies.
From Measuring “Clicks” to Measuring PerformanceBy Beth Pitman | 03-03-2016
CMS administrators Andy Slavitt and Karen DeSalvo have made numerous comments recently about the future of meaningful use and other government initiatives around data governance.
Bundled Payments: Are They Finally Here?By Colin Luke | 02-09-2016
Healthcare providers are attempting to move toward population health. But without a mandate, progress to date has been slow. This will soon change with CMS' CCJR Model, which will go into effect on April 1, 2016.
DOL Final Rule Impacts Home Health “Companionship Services” ExemptionBy Mark Peters | 02-01-2016
The DOL began enforcing its Final Rule extending overtime and minimum-wage protections to most home care workers previously deemed exempt in January. The home health industry has been busy looking for ways to minimize the impact of the DOL decision.
Hospitals Hit Hard in 2015 False Claims Act EnforcementBy J.D. Thomas | 12-08-2015
Last week, the DOJ announced another multi-billion dollar yearly haul from FCA enforcement -- totaling over $3.5 billion for FY 2015. Of that total, the majority came from the healthcare industry.
Real Estate as a Tool for Improving Physician AlignmentBy Jeffrey A. Calk | 10-27-2015
Today, every hospital and health system is looking for strategic opportunities to improve its alignment with physicians. These efforts often involve the acquisition of physician practices, employment of physicians and strategic joint ventures.
OIG Takes Aim at Skilled Nursing Therapy BillingBy Jeff Parrish | 10-08-2015
The Department of Health and Human Services’ Office of Inspector General issued a report, “The Medicare Payment System for Skilled Nursing Facilities Needs To Be Reevaluated,” in which the OIG was very critical of SNF therapy billing.
Thoughts from the 2015 AHLA Fraud and Compliance ForumBy J.D. Thomas, Meredith Toole | 10-01-2015
Once again, AHLA outdid itself and put on an excellent program at the 2015 Fraud and Compliance Forum. The program combined a unique mix of speakers from government, in-house legal and compliance personnel and outside counsel with timely and interest
Healthcare Data Analytics Patent Subject to “CBM” Review at USPTOBy Matthew C. Cox, Charlie Walker | 09-29-2015
On September 10, 2015 in the case Symphony Health Solutions Corp. v. IMS Health Inc., (CBM2015-00085) the U.S. Patent Trial and Appeal Board (“PTAB”) granted institution of a Covered Business Method (CBM) review under the Leahy-Smith America Inve
Meaningful Use Rules Under Review by the OMBBy Beth Pitman | 09-10-2015
CMS sent the long-awaited final rule that modifies the requirements of the Meaningful Use program Stages 1 and 2, as well as the rule implementing Stage 3, to the OMB.
DOL Asks D.C. Circ. for Quick Approval of Home Care RuleBy Mark Peters | 09-04-2015
Since October 2013, when the Department of Labor issued a Final Rule extending overtime and minimum-wage protections to most home care workers previously deemed exempt, the home health industry has been on pins and needles.
CMS Issues Proposed Stark Law ModificationsBy Kristen A. Larremore | 08-04-2015
In July, CMS published a draft update to the Medicare Physician Fee Schedule for 2016, which included proposals that aim “to reduce burden and to facilitate compliance” under the physician self-referral law known as the Stark Law.
A Healthy Dose of Data Security AwarenessBy Steve Blumenthal | 07-22-2015
At Waller’s latest Healthcare and Big Data panel discussion, we were joined by industry experts to discuss healthcare data breaches. While data security threats arise in a variety of contexts, the risk of healthcare data breaches can be reduced thr
CMS Prepared to Modify Controversial Two-Midnight RuleBy Fletcher Brown, J.D. Thomas | 07-17-2015
Earlier this month, CMS released the Hospital Outpatient Prospective Payment System (HOPPS) Proposed Rule for CY 2016. While there are a number of payment updates proposed in the plan, the two-midnight rule is garnering most of the attention.
Tuomey Decision Signals Concerns About Stark LawBy J.D. Thomas, Meredith Toole | 07-16-2015
Earlier this month, the Fourth Circuit federal appeals court upheld a district court’s $237 million FCA verdict against Tuomey Healthcare System for Stark Law violations. The sum is believed to be the largest ever levied against a community hospita
House Passes 21st Century Cures ActBy Michael Staley | 07-10-2015
Today, the U.S. House of Representatives passed H.R. 6, the 21st Century Cures Act, with a bipartisan vote of 344-77. The legislation is intended to accelerate “the discovery, development and delivery of life saving and life improving therapies.”
OIG Issues Fraud Alert Targeting Physician CompensationBy Angela Youngberg | 06-23-2015
The Office of the Inspector General issued a Fraud Alert on June 9, 2015 that highlights the OIG’s intent to continue and to strengthen its focus on physicians who enter into questionable compensation arrangements with hospitals, nursing homes and
Congress Opens the Medicare Data ToolboxBy Steve Blumenthal | 06-22-2015
The “Doc Fix” law includes a few subtle lines that may expand the use of Medicare claims data to develop new models of patient care.
Setting the Stage for InteroperabilityBy Steve Blumenthal | 06-11-2015
The “Doc Fix” got most of the coverage when Congress passed the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), but the bill also established numerous requirements and deadlines with respect to achieving interoperability with health
OIG Issues Latest Report Targeting Dental ProvidersBy J.D. Thomas | 05-26-2015
The Office of the Inspector General (OIG) has issued its latest report in its state-by-state series examining pediatric dental services provided under Medicaid. This newest report examines such practices in California.
Advocates and Critics Contemplate 21st Century Cures ActBy Elizabeth Sillay | 05-14-2015
Over the last year, the U.S. House Energy and Commerce (E&C) Committee has engaged in a broad public conversation about what steps can be taken to bridge the gap between advancements in science and the approval of new medical therapies, and how to re
Financial Experts Discuss Deal-Making TrendsBy Morgan Ribeiro | 05-08-2015
Recent reports continue to show that deal volume in the healthcare industry is at an all-time high. The Nashville Health Care Council continued this ongoing discussion during its “Financing the Deal” event.
April Showers Brought Changes to Telehealth LawsBy Angela Youngberg | 05-05-2015
Telehealth is exploding in both popularity and use as it has been shown to be convenient, affordable and of high quality. On both a federal and Tennessee level, the field of telehealth continues to gain attention and garner changes in the law.
HIMSS15: It Was All About the PieBy Steven Blumenthal | 04-23-2015
Nearly 43,000 people descended upon Chicago last week for the annual HIMSS meeting. We've recapped some of the biggest events of the week and key topics of discussion.
SGR Formula Comes to a CloseBy Angela Youngberg | 04-20-2015
In a rare bipartisanship vote, the “doc-fix” bill that cleared the Senate and was signed by President Obama last week put the 15-year-old sustainable growth-rate (SGR) formula to an end.
What is Net Neutrality and Why Should You Care?By Angela Youngberg | 04-14-2015
The controversial Internet rules will forbid Internet service providers to speed up, slow down or block a consumer’s access to any particular content.The policy is particularly relevant to healthcare.
Tips on and Trends in Healthcare IT InvestmentsBy Rob Harris, Tyson Bickley | 04-02-2015
On Tuesday, Waller hosted the second installment of our Healthcare and Big Data panel series. We were joined by Vic Gatto of Jumpstart Foundry, Jesse Bland of the Heritage Group, and William Seibels of Change Healthcare.
MedPAC Issues 2015 Report to CongressBy Denise Burke, Angela Youngberg | 03-18-2015
Last week, MedPAC – the Medicare Payment Advisory Commission – issued its annual report to Congress on the Medicare fee-for-service (FFS) payment systems, the Medicare Advantage program, and the Medicare prescription drug program (Part D).
An Update from Leadership Health Care’s Delegation to D.C.By J.D. Thomas, Cory Brown | 03-13-2015
Earlier this week, we attended the Leadership Health Care delegation to Washington, D.C., where we were joined by 100 of our fellow Nashville healthcare industry friends to learn more about the policy and politics shaping our industry this year.
Alignment Continues for Providers and InsurersBy Brian Browder | 02-23-2015
More providers are partnering with payors to position themselves for population health management. We foresee several potential obstacles, however, to the success of this collaboration among competitors.
Healthcare Fraud Enforcement and the DOJ’s Greatest HitsBy J.D. Thomas | 02-09-2015
In 2014, the department of justice obtained $2.3 billion in healthcare fraud recoveries and 2015 will be another significant year for False Claims Act enforcement - particularly as it relates to hospitals and associated providers.
Data Analytics is (Still) the Next Big ThingBy Steven Blumenthal | 02-06-2015
My not-so-bold prediction for 2015 is that it’ll be a busy year for the healthcare data analytics business. I admit that making 2015 predictions now is a little like placing a bet after the horses have run the first quarter mile...
CMS Flinches on Meaningful UseBy Angela Youngberg | 02-04-2015
Five years after the HITECH Act, the meaningful use incentive program for electronic health records (EHRs) is still confusing providers.