Recent Court Actions Provide Insight into Future of Fraud & Abuse Laws

Two recent court actions may serve as harbingers for the future of healthcare fraud and abuse laws. In September 2024, a federal judge in the Southern District of West Virginia ordered parties in a qui tam False Claims Act and Stark Law case to brief the court on the implications of Loper Bright Enterprises v. Raimondo on the interpretation of the Stark Law to the case at hand. That same month, a federal judge in the Middle District of Florida dismissed a qui tam lawsuit on a novel theory that the False Claims Act’s whistleblower provisions are unconstitutional. This Health Capital Topics article discusses these cases and the potential impact on federal fraud and abuse laws. (Read more...)

Where the Candidates Stand on Healthcare

With the Presidential Election just weeks away, healthcare has once again come front and center of national political discourse, as voters rank healthcare as an important issue, and Vice President Kamala Harris and former President Donald Trump tout their respective healthcare agendas. While details related to future healthcare proposals have been light, both candidates do have political track records that can be examined for clues as to their priorities should they become president. This Health Capital Topics article explores where the candidates stand on various issues related to healthcare. (Read more...)

OIG Recommends Higher Scrutiny of RPM

On September 24, 2024, the Office of Inspector General (OIG) of the Department of Health & Human Services (HHS) issued a report recommending additional oversight of remote patient monitoring (RPM). RPM, also called remote physiologic monitoring, “is the use of digital devices to monitor a patient’s health.” OIG’s report, which examined RPM claims between 2019 and 2022, focuses on three main issues: (1) providers failing to use RPM as intended; (2) fraud and abuse concerns related to RPM; and (3) a lack of information related to the use of RPM for Medicare patients. This Health Capital Topics article reviews the report and discusses industry reactions. (Read more...) 

Valuation of Hospitals: Reimbursement Environment

The U.S. government is the largest payor of medical costs, through Medicare and Medicaid, and has a strong influence on reimbursement to hospitals. In 2022, Medicare and Medicaid accounted for an estimated $944.3 billion and $805.7 billion in healthcare spending, respectively. The prevalence of these public payors in the healthcare marketplace often results in their acting as a price setter, and being used as a benchmark for private reimbursement rates. This third installment of the series discusses the reimbursement environment in which hospitals operate. (Read more...) 

A recent HCC authored article entitled "Valuation Standards in Healthcare" was published by the National Association of Certified Valuators and Analysts (NACVA) in the September/October issue of The Value Examiner.

For more recently published material written by HCC, please visit www.healthcapital.com

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"Federal Judge Strikes Down Ban on Noncompete Agreements" authored by HCC President, Todd A. Zigrang, MBA, MHA, FACHE, CVA, ASA, ABV, and, HCC Senior Vice President and General Counsel, Jessica Bailey-Wheaton, Esq., was published by the National Association of Certified Valuators and Analysts (NACVA) in QuickRead.

For more recently published material written by HCC, please visit www.healthcapital.com

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