Brian A. Colao

This case hit the trifecta of highly enforced areas in healthcare: DME, lab and telemedicine. If you are working in any of these spaces and have not reviewed your compliance programs recently, reach out and let's do a check to make sure you are on the right track to protect your practice. #healthcareenforcement #labenforcement #genetictesting #DMEenforcement #OIGenforcement

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Phoenix Healthcare is an Oklahoma based long term care provider. Due to HIPAA violations Phoenix Healthcare entered into a settlement agreement with the Dept of HHS-OCR. In April 2019, a complaint was filed with OCR alleging that Phoenix Healthcare failed to provide a family member (a daughter who was also an authorized individual to gain access to PHI) with a copy of her mother’s medical records within the required timeframe. Phoenix Healthcare sent the record 323 days after the request on January 30, 2020. The HIPAA Right of Access provision requires individuals or their representatives to have timely access to their health information. A covered entity must provide access to the protected health information within 30 days of receiving an individual’s request. Healthcare providers who are also covered entities under HIPAA must comply with these standards. Failure to comply could result in similar on-going obligations set forth in the settlement agreement, including, but not limited to civil monetary penalties (CMPs), creating / amending policies and procedures requiring OCR approval, submitting training materials and much more. https://lnkd.in/g8nYNV2C

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The third edition of Foley's 50-State Survey of Telehealth Insurance Laws is now available. This report provides a detailed analysis of each state's telehealth commercial insurance coverage and payment/reimbursement laws. It also offers a comparison of these laws before and after the Public Health Emergency. #Telehealth #Insurance #Commercial

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T.J. Ferrante, vice chair of Foley's Health Care Practice Group, is speaking during Spruce Health's upcoming webinar, "U.S. Federal and State Telehealth Law & Policy—2024 & Beyond," on June 12. This panel will examine the current regulatory landscape as it relates to digital health. Click below to learn more and register. #Webinar #Telehealth #HealthLaw

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Thompson Coburn Dallas partner Katie Clark is recognized in the 2024 Lawdragon 500 Leading Bankruptcy & Restructuring Lawyers list. The rankings highlight top law professionals who help those impacted "when companies go bust, need to transition or work through difficulties." Congrats, Katie! Read more here: https://bit.ly/45zBpbD #bankruptcylaw #dallaslawyers

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Listen Here: https://lnkd.in/ge_hJ8y8 Tune in as Erik Summers, Chief Medical Officer at Atrium Health Wake Forest Baptist, shares insights into healthcare trends and strategic growth. Gain valuable perspectives on implementing impactful changes and navigating future developments in the healthcare landscape. For more information about Becker's Healthcare, please contact Jessica Cole or Scott Becker. #podcast #healthcare #leadership

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In a significant change to its #Medicaid regulations, #CMS published two Final Rules that impose new requirements on state and Medicaid managed care plans that will enhance and standardize reporting, monitoring, and evaluation of Medicaid access to services. My colleague Anil Shankar provides of summary of the key provisions in the blog post below. #healthcare

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In a significant change to its #Medicaid regulations, #CMS published two Final Rules that impose new requirements on state and Medicaid managed care plans that will enhance and standardize reporting, monitoring, and evaluation of Medicaid access to services. My colleague Anil Shankar provides of summary of the key provisions in the blog post below. #healthcare

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In case you missed it: CPLG Chairman David S. Cohen, Esq. co-hosted the ‘DSO Decision’ podcast with Brian Hanks. During the episodes, David and Brian tackled subjects like signing leases and the general topic of DSOs. Brian’s career in dental accounting and transitions and David’s career in dental law give them the experience and knowledge to share their wisdom. Take a listen to the real estate-focused episodes; 12, 13, and 14 here: #southflorida #legalnews #news #lawfirm #legal #attorneys #lawyers #southflorida #southfloridalawfirm #propertylaw #realestate #realestatelaw #CREnews #realestatenews #realestatedevelopment #propertymanagement #CRE #realestatebrokers #realestatedevelopers

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Find my article on 2024 Legal Considerations for Healthcare Providers covering Anti-Kickback, False Claims Act, Stark Law and issues surrounding artificial intelligence starting on page 14. #healthcare #aks #stark #fca #artificialintelligence

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I enjoyed speaking with Law360's Senior Bankruptcy Reporter, Vince Sullivan, on the state of the healthcare industry and the financial pressures faced by small and standalone providers. Chapter 11 bankruptcy can be an effective tool to facilitate a transaction "free and clear" of legacy liabilities, providing a clean slate for a fresh start. The article is available for free if you sign up to Law360. #bankruptcy #healthcare #transaction

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Shoutout to Constantine Cannon Partner Marlene Koury who was featured in Law360 to discuss the DOJ's recent decision to intervene in U.S. v. All Heart Pharmacy Inc. et al, a kickback case focused on a Florida based compounding pharmacy! Koury explained that the DOJ has high success rates in cases it intervenes in and noted the agency's increased focus on kickback cases due to the high cost of such schemes to the healthcare system and the relative ease of evaluating evidence compared to other healthcare fraud cases. Koury says that proving kickback cases is “usually pretty straightforward...[t]here's not a lot of patient files you need to rifle through. With other healthcare cases, sometimes you need to go through mountains of patient data.”  Compounded drugs, tailored to meet specific patient needs, often come with high costs, making them a target for fraudulent schemes. Follow us for more updates from our Whistleblower team! To subscribe to our Whistleblower Insider Blog and Newsletter to hear the latest stories, follow the link here > https://lnkd.in/eY4H6E6X

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Listen Here: https://lnkd.in/gB9aaPTG In this episode, Alan Condon, Editor-in-Chief at Becker's Healthcare shares updates surrounding the latest financial results coming out of Kaufman Hall & current mergers and acquisitions moving forward in the healthcare industry. For more information about Becker's Healthcare, please contact Jessica Cole or Scott Becker. #podcast #healthcarenews #healthcaretrends

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Last Friday (June 7, 2024) Judge Randolph Moss from the District Court of Columbia issued a memorandum opinion and order that granted relief to Elevance’s contract H5422 (BCBS of Georgia), while not conceding it for the remaining contracts included in the lawsuit.   Here's what you need to know from our Strategy Officer Nate Lucena and Policy & Data Analyst Angelo L. Rexach Guzmán :    1. Court’s Decision: - CMS contended that only contract H5422 (BCBS of Georgia) had shown sufficient evidence of injury due to alleged regulatory violations. - The court agreed with CMS, ruling that only BCBS of Georgia was entitled to the relief sought by the Plaintiffs.   2. Elevance's Evidence: - To demonstrate standing, Elevance brought in an expert to analyze the cutpoints, showing the impact of CMS’s use of simulated instead of actual 2023 Star Ratings cutpoints. - The analysis showed that contract H5422 would have received a higher star rating for C25, D01, D02, increasing from 3 stars to 3.5 stars overall.   3. Plaintiffs' Shortcomings: - Plaintiffs did not provide additional evidence for other contracts, nor could they prove that other contracts would be similarly affected by CMS's actions. - The Court found insufficient argument or evidence to establish standing for the other contracts involved.   4. Consistency across Scan and Elevance decisions: - Judge Moss's decision aligns with the recent ruling published by Judge Nichols in the Scan lawsuit, emphasizing that CMS must adhere to regulatory requirements rather than preamble statements. - Furthermore, Judge Moss referred to Judge’s Nichols decision on Scan Health Plan lawsuit on a couple of occasions as part of the evaluation of the use of Simulated 2023 Cut Points in 2024 Star Ratings.   What’s Next?  - The 2024 Star Ratings for BCBS of Georgia will be set aside, and CMS must redetermine these ratings according to the court’s opinion. - CMS may extend similar relief to other Medicare Advantage Organizations (MAOs) through the administrative process. However, CMS has not stated how they will handle issues with other contracts. - Yesterday (June 10) Zing’s Attorney filed a notice of supplementary authority including both SCAN Health Plan and Elevance’s memorandum opinions as exhibits for the ongoing case with CMS. If you are a health plan considering similar litigation, please make sure that your expert(s) have the proper and sufficient data to clearly show you had a difference in your Star Ratings performance. If you're not sure where to start, reach out to Angelo.Rexach@rexwallaceconsulting.com or Nate.Lucena@rexwallaceconsulting.com to assist your team on the most effective path forward. #StarRatings #CMS #MedicareAdvantage https://lnkd.in/egemSH5s

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Is it worth it for health care employers to litigate non-compete agreements against physicians? Tune in to the Spilling Secrets podcast: https://lnkd.in/eNPPnWDd #HealthCare #Physician #Noncompetes #WorkforceWednesday

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