Entries tagged: healthcare

Providers, Take Note: Cigna Increases Its Recovery Efforts

By: William McDonald, Esq.

Posted: March 29th, 2017

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Long Island medical providers have learned that Cigna is once again striving to “recover” payments made to them. Cigna’s investigation focuses primarily on out-of-network providers, since it believes that its contract language with self-funded ERISA plans entitles it to recover payments made for out-of-network services. Cigna employs a classic flanking maneuver to box in the […]

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Hospital Patients Are Entitled to Admission Status Information

By: Martin Glass, Esq.

Posted: December 20th, 2016

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Last year, President Obama signed the Notice of Observation Treatment and Implication for Care Eligibility Act (better known as the “NOTICE Act”).  The NOTICE Act became effective on August 6, 2016.  It may not seem like a big deal, but the Act requires hospitals to inform patients whether the patients have been admitted to the […]

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Disclosure of Protected Health Information: It’s Not All About HIPAA

By: William McDonald, Esq.

Posted: December 19th, 2016

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    Anyone who’s had a doctor’s appointment in the past 20 years is familiar with the Health Insurance Portability and Accountability Act (known affectionately—or not—as HIPAA).  Undoubtedly, if your business collects and shares protected health information, you and HIPAA are old friends.  However, many healthcare providers don’t realize that HIPAA isn’t the only game […]

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OMIG Update: December 31 Certification Requirement for Compliance

By: William McDonald, Esq.

Posted: November 21st, 2016

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      The New York State Office of the Medicaid Inspector General: Reminder of Certification Requirement for Compliance Programs and DRA Obligations As a reminder for Medicaid providers subject to New York’s mandatory compliance program obligation in Social Services Law section 363-d and 18 NYCRR Part 521, the December Annual Certification period expires December 31, […]

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Life Science Companies under Increasing DOJ and SEC Scrutiny for Anti-Corruption Enforcement

By: Jack Harrington, Esq.

Posted: August 23rd, 2016

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The pharmaceutical and medical device industry has always been among the most heavily regulated in the United States.  In recent years, however, these companies have become the subject of another regulatory and law enforcement focus: the Foreign Corrupt Practices Act (FCPA). The FCPA is a federal law that prohibits U.S. persons, companies, and issuers from, […]

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Lessons Learned From The Novartis FCPA Settlement

By: Jack Harrington, Esq.

Posted: July 25th, 2016

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    Last spring, Swiss pharmaceutical giant Novartis AG paid $25 million to the SEC to settle Foreign Corrupt Practices Act (“FCPA”) charges relating to its operations in China.  According to the SEC’s internal administrative order, Novartis subsidiaries in China bribed government-affiliated doctors and healthcare professionals—who qualify as “foreign officials” under the FCPA—to increase sales […]

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No-Fault Carrier Not At Fault for Faulty Billing: Billing Confusion Creates Potential Liability for Healthcare Providers

By: Scott Middleton, Esq.

Posted: June 23rd, 2016

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A recent New York State Court of Appeals decision, Aetna Health Plans v. Hanover Insurance Company (NY Slip Op 04658, June 14, 2016), creates yet another worry for doctors and patients with respect to medical billing and ultimate responsibility for those bills. The issue presented is whether a health insurer that pays for medical treatment […]

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Overthinking Overpayments from Medicare

By: William McDonald, Esq.

Posted: June 15th, 2016

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    Since passage of the Affordable Care Act, compliance officers and attorneys have struggled to comply with the new rule requiring notification and repayment of Medicare overpayments within 60 days.[i]  The two large questions that remain unclear are what constitutes an “overpayment,” as well as what it means to “identify” an overpayment. Section 6402(a) […]

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Court of Appeals Ponders “Extreme and Outrageous” Conduct

By: Patrick McCormick, Esq.

Posted: June 13th, 2016

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If it isn’t extreme and outrageous to film a trauma patient’s last minutes alive, the pronouncement of his death, and the family notification, then broadcast those intimate moments on national television in the name of entertainment, all without consent – then what is? A recent decision from the New York State Court of Appeals leaves […]

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New York City Human Rights Law Amended to Include “Caregiver” Status

By: Vincent Costa, Esq.

Posted: April 25th, 2016

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In 2015, the State of New York added “familial status” as a class of persons protected under state discrimination laws, prohibiting discrimination against pregnant employees and employees with minor children.  On May 4, 2016, the New York City Human Rights Law (“NYCHRL”) will add a new protected class that offers an even greater degree of […]

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