On December 18, 2023, the Federal Trade Commission (“FTC”) and the Antitrust Division of the Department of Justice (“DOJ”) issued a final version of their Merger Guidelines. Initially proposed in July 2023, after five months of public commentary and feedback and two years of work in total, the 2023 Merger Guidelines include 11 enforcement principles
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Class Actions Highlight AI-Assisted Payer Denials
As health care payers increasingly rely on artificial intelligence (“AI”) to speed up patient claim adjudication and prior-authorization determinations, providers should be on the lookout for algorithms designed to deny claims with minimal
human oversight. Two putative class action lawsuits filed against Cigna and UnitedHealth in November 2023 allege that the payers’ respective AI models,…
OIG Update Modernizes Compliance Program Guidance
For the first time in 15 years, the Office of Inspector General (OIG) has issued updated compliance program guidance. The release of this guidance is part of the OIG’s two-step approach to modernize its current compliance program guidance. In April 2023, the OIG indicated that it would publish general compliance program guidance by the end…
OCR Issues New Telehealth Guidance
Last week, the Office for Civil Rights (“OCR”) released two new resources designed to assist patients in understanding the privacy and security risks to their health information associated with using telehealth, and steps that can be taken to reduce those risks.The first document provided by OCR is intended to serve as a resource for providers…
Upcoming Changes to Various Federal Laws Impacting the Health Care Industry
Pumpkin spice is on all the shelves and the winter holidays are fast approaching. But as we enter into the final few months of 2023, the health care industry should also remember to make note of and prepare for a number of changes that are expected to occur in late 2023 or early 2024. Below…
OIG Publishes New “Featured Topic” on Managed Care Oversight
By Nicole Jobe & Taylor Trippe
On August 28, 2023, the U.S. Department of Health and Human Services Office of Inspector General (“OIG”) published a new “Featured Topic” webpage on managed care oversight. The OIG’s Featured Topics include compilations of the OIG’s existing work related to a specific subject matter area and are updated as new material is published. Due to…
Blog Browse: Get to know the new I-9 requirements
There have been a number of changes to Form I-9 that employers should know. In a recent article, employment and immigration partner Carlos Ortiz laid out the changes and key dates relevant to Form 1-9 changes. Read more here.
Subjective Intent in False Claims Act: Navigating Ambiguity in Health Care Reimbursement Claims
At the intersection of law and business, ambiguity can present significant challenges. But one thing seems apparent under the False Claims Act (“FCA”) for health care entities submitting reimbursement claims to the government: if you
subjectively believe that your claims are or might be false, you likely have the requisite intent to violate the FCA.…
Illinois Passes Legislation Requiring Attorney General Notice of Certain Health Care Transactions
The Illinois legislature recently passed new antitrust legislation (“HB2222”) that will require advance notice to the Attorney General for health care facilities and health care provider entities engaging in certain covered transactions. If signed by the Governor, the new legislation will go into effect January 1, 2024. HB2222 would provide the Attorney General with notice of…
New OIG toolkit: Analyzing Telehealth Claims for Program Integrity Risks
By Milada Goturi & Kevin Kifer
On April 20, 2023, the U.S. Department of Health and Human Services Office of Inspector General (“OIG”) published a new toolkit titled “Analyzing Telehealth Claims to Assess Program Integrity Risks” designed to analyze claims data for telehealth services and identify program integrity risks to Federal healthcare programs (“Toolkit”). The Toolkit appears to be driven by the…