Blogs

Congress is advancing proposals that may drastically cut federal support for state Medicaid programs. Zeke Shen breaks down how the state funds Medicaid and what’s at stake under proposed reforms.

What is a health care provider to do when law enforcement comes knocking and the target is a patient? Stephane Fabus highlights the legal and compliance considerations for navigating interactions with law enforcement officials, given the recent changes inreproductive health privacy and the rollback of ICE’s Protected Areas policy.

Workers in health care industries face the highest rates of workplace violence. Christopher Toner discusses how attorneys can help their health care clients take proactive steps to provide a workplace free of violence.

Accurate documentation in medical records is central to patient care and is central to maintaining a health care provider’s ability to practice. Kristen Nelson discusses specific violations of poor documentation and how attorneys can work proactively withclients to avoid them.

As the so-called silver tsunami hits health care, many physician-owners of ambulatory surgery centers are preparing for retirement. Angela Rust describes succession-planning challenges attorneys should raise to address compliance with the Anti-kickback Statute.

Attorneys can help pharmacists navigate their statutorily defined duties and scope of practice, which are constantly evolving. Alexandra Guzek provides an overview of the statutes governing pharmacy practice Wisconsin and how standing orders and collaborative practice agreements can expand pharmacists' scope of practice.

The Federal Trade Commission's ban on noncompete agreements may take effect Sept. 4. Tom O’Day and Audrey Merkel discuss the impact the ban could have on the health care industry and what employers can do now to prepare.

Several federal agencies in 2023 proposed a new rule to address treatment challenges to the growing mental health and substance use crises in the U.S. Elicia Grilley Green and Noreen K. Vergara discuss the new proposed rule to enforce the Mental HealthParity and Addiction Equity Act (MHPAEA).

Fiscal year 2023 was record breaking for the U.S. Department of Justice’s False Claims Act settlements and judgements. Leah Ruedinger reviews several settlements and lists best practices for compliance.

The Wisconsin legislature is now in full session. Amy Bradshaw and Sarah Coyne highlight Wisconsin’s approach to surrogate decision-making, involuntary psychiatric holds, abortion, and medical malpractice.

There were many changes to the labor landscape for health care organizations in 2023. Christopher Toner provides a labor law update for health care organizations that employ both union and non-union workforces.

The Wisconsin enhanced prescription drug monitoring program (ePDMP) helps combat the opioid crisis. It is successful if both dispensers and prescribing practitioners comply. Failing to comply hurts patients and has licensing and criminal consequences for the practitioners, writes Kristen Nelson.

On July 1, 2023, the Wisconsin Medical Examining Board enacted changes to chaperone policies for self-employed physicians. Meghan Wallace discusses the requirements of the new rule and the considerable differences between the original proposed rule and the final rule.

The proposed H.R. 7213 bill and 2021 Wisconsin Act 98 expands provider status for pharmacists. Alexandra Guzek discusses the benefits and possible impact on pharmacists and communities.

The Center for Medicaid & Medicare Services (CMS) recently published a proposed rule with the goal of increasing transparency between nursing homes and consumers. Denisha Renovales breaks down the proposed rule and how it could impact nursing homes.

Xylazine-laced fentanyl was recently declared an official emerging drug threat to the nation. Amy Bradshaw discusses the response as well as current opportunities related to substance use disorder treatment and harm reduction.

The U.S. Department of Justice (DOJ) recently announced that in 2022, it recouped False Claim Act settlements and judgments amounting to the second highest number of settlements in history. Leah Ruedinger discusses the settlements and offers tips for effective compliance programs for health care entities.

Will the current wave of pending litigation around the issue of race in admissions before the U.S. Supreme Court result in the end of affirmative action? Catarina Colón, Jack Quinn, and Annie Cartwright discuss the issue and that now is a good time for medical schools to assess the impact of potentially shifting case law on diversity practices and initiatives.

Since the U.S. Supreme Court overturned Roe v. Wade, Wisconsinites are in the challenging position of interpreting an abortion law originally codified in the mid-1800s. Richard Davis discusses this law and its enforcement, and what it can mean forfor physicians and lawyers in the state.

Negotiated rates between health care providers and health plans, once considered top secret, are now revealed due to new price transparency laws. Angela Rust discusses the trend toward greater transparency and offers tips for providing guidance toproviders and plans in light of these developments.

The U.S. Department of Justice’s recent criminal prosecutions of health care executives for no-poach and wage-fixing conspiracies have been met with not-guilty verdicts. Despite these losses, Wendy Arends says that the Department continues to prosecute this conduct, and that antitrust enforcers will investigate human resources practices that may restrain competition.

The complex laws governing Medicare providers are filled with landmines. Understanding the basics of who, what, where, and how of Medicare exclusion works help health care professionals avoid this limiting consequence, says Kristen Nelson.

According to a recent Department of Justice release, the department recouped its second largest ever annual total from civil False Claims Act Claims. Leah Ruedinger discusses the types of claims over the past year and offers advice to help clients toavoid facing such claims.

Robin Sheridan and Jessica Biondo discuss two recent U.S. Supreme Court rulings regarding mandatory COVID-19 vaccination rules from the Centers for Medicare & Medicaid Services and the Occupational Safety and Health Administration.

Three recent pieces of legislation seek to remove barriers to medical practice and expand access to medical care. Kristin Degeneffe discusses how these changes may affect physician assistants, advanced practice nurse practitioners, and out-of-state medical providers.

For nearly two years, health lawyers have been swamped with issues related to the COVID-19 pandemic. But the “new normal” means juggling those issues on top of more conventional ones. Amy Bradshaw highlights three recent non-COVID developments for her Wisconsin health law colleagues.

In 2020, the federal 340B Drug Pricing Program experienced an upheaval after some manufacturers cut the number of contract pharmacies obtaining drugs at a lower price and federal Health Resources and Services Administration Office of Pharmacy Affairs stepped up its enforcement authority. Richard Davis discusses the program, the surrounding litigation, and what’s next.

A recent interim final rule from the Centers for Medicare & Medicaid Services requires health care providers and suppliers to establish COVID-19 vaccination requirements for all covered staff – and the vaccination deadline is fast approaching. John Rubin provides an overview of the rule, its required provisions, and the penalties.

The Office of the Inspector General’s first Special Fraud Alert in six years highlights a growing concern about sponsored speaker programs and the potential implications for fraud and abuse actions under the anti-kickback statute. Leah Ruedinger discussesthe implications of this Special Fraud Alert.

This month, the 21st Century Cures Act Information Blocking Rule took effect. Jonathan Klock provides a brief overview of the rule, key exceptions and tips for compliance, and helpful resources for more information.

Little used before COVID-19, the Public Readiness and Emergency Preparedness (PREP) Act aimed to shield drug makers from liability when bringing vaccines to market during a public health emergency. Stephen Veit gives an overview of the Act and discusses recent cases involving health care providers in the COVID-19 era.

Employers and health care providers across the country are opting to participate in Centers of Excellence Programs and will need to meet the legal requirements of every state in which they do so. Angela Rust helps attorneys for providers and health plans spot these state law issues of importance, with specific commentary on Wisconsin.

IRIS (Include, Respect, I Self-Direct) is a Medicaid long-term care program that allows eligible Wisconsin residents to live in their own home, while self-directing support and services. Julianne M. Cox discusses the program, enrollment, and its benefits and services.

Artificial intelligence-based technologies that forecast future medical conditions are coming into mainstream use. Kristin Degeneffe discusses the choices health care organizations face in determining how fully to embrace these trends in 2021 and beyond.

In July 2020, the Wisconsin Supreme Court struck down an exacting payment recoupment standard for Medicaid providers by the Wisconsin Department of Health Services. Diane Welsh and Aaron Dumas discuss the decision and what it means for the department’s audits and recoupment efforts in the future.

A rule proposed by U.S. Department of Health and Human Services requires its components to inform the public when issuing a “guidance document” and to clarify the document’s legal impact. James Junger and Heather Mogden discuss the proposed rule and how to petition a review of guidance documents that may go too far.

Early in 2020, the Health Resources and Services Administration Office of Pharmacy Affairs seemed to scale back regulation of the 340B Program, which reduces drug costs for health care facilities that serve vulnerable populations. Richard Davis discusses the issue, which may result in the cost of 340B-covered drugs rising dramatically for contract pharmacies.

When a licensed health care professional is arrested, what should happen next? Kristen Nelson offers guidance and considerations for attorneys when their client is a licensed health care professional who is arrested or convicted.

The federal and state responses to COVID-19 significantly changed the rules governing health care providers. Heather Mogden, et. al., outline six pitfalls and practical takeaways for health care clients to avoid them.

The recently-enacted CARES Act made several amendments to the law governing the confidentiality protections afforded to substance use disorder records. Stephane Fabus discusses the top 10 changes and offers advice on how providers should prepare before the changes become effective in 2021.

As the health care industry grapples with the rapid spread of the COVID-19 pandemic, interruptions from the industry’s key suppliers are inevitable. Peggy Barlett discusses certain considerations that the industry should be proactively thinking about as the interruptions in the supply chains impact daily operations and patient care within the industry.

Supported decision-making agreements provide a means for individuals with functional impairments to maintain their self-determination when making decisions. Leah Ruedinger breaks down the scope of a supported decision-making agreement and discusses the role of the supporter in assisting individuals with functional impairments.

With rising health plan costs, employers are seeking alternatives to the traditional provider networks, such as reference-based pricing. Angela Rust explores this health care payment model – and offers advice for health law attorneys with clients exploring reference-based pricing.

Three cases currently before the U.S. Supreme Court address whether the federal government is required to pay health insurers money under the risk corridors statute. Richelle Ladwig reviews the cases and its implications. “At stake is whether the government can be a trusted business partner for private entities,” she writes.

Health care entities have faced uncertainty when conforming physician compensation arrangements to federal requirements involving fair market value, commercial reasonableness, and potential tie-ins to physician referrals. Madeline Schmid and David Edquist review new rules proposed by the Centers for Medicare & Medicaid Services that offer clarity, and relief, on these issues.

Family Care is a Medicaid long-term care program that allows eligible Wisconsin to reside in their own homes while receiving high-quality support and care management. Julianne Cox discusses the program, enrollment, and its benefits and services.

The recent conviction of the physicians, investors, and staff of a Dallas hospital on fraud and other charges is an opportunity for lawyers to review their clients’ contractual relationships and internal compliance programs. David Edquist, Stacy Gerber Ward, and Daniel Balk III discuss the case and the state and federal statutes that prosecutors used to obtain convictions.

When does a workplace data collection become a medical inquiry? Barbara Zabawa discusses the notice requirements of workplace wellness programs.

The CMS Preclusion List – a list of providers who are prohibited from being paid for services provided to Medicare Parts C and D beneficiaries – is now in effect. Scott Taebel, James Junger, and Julie Lappas discuss this list and offer tips for attorneys who advise health care providers.

If you have ridden in an Uber, booked a stay through Airbnb, or downloaded something from the Apple App Store, you are participating in the platform economy. Angela Rust offers three considerations for attorneys advising clients as the platform economy changes the health care landscape.

By including private insurers in its definitions, the Eliminating Kickbacks in Recovery Act brings a "seismic shift" to the fraud and abuse landscape, says James Junger. He discusses the Act and its implications for health care insurers and providers.

The new Health Law Blog is designed to deliver the latest news, practical advice, and valuable resources that focus on issues in the health law field.