May 18, 2015

Westchester Medical Center Settles Anti-Kickback and Stark Claims for $18+ Million

Preet Bharara, US Attorney for the Southern District of New York, announced the settlement Thursday by way of a press release.

Preet Bharara, the United States Attorney for the Southern District of New York, Scott J. Lampert, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General's ("HHS-OIG") New York Region, and Diego Rodriguez, the Assistant Director-in-Charge of the New York Office of the Federal Bureau of Investigation ("FBI"), announced today that the United States has settled civil fraud claims under the False Claims Act against WESTCHESTER COUNTY HEALTH CARE CORPORATION d/b/a WESTCHESTER MEDICAL CENTER ("WMC") related to WMC's alleged violations of the Anti-Kickback Statute and the Stark Law and submission of costs reports to Medicare seeking reimbursement for charges WMC did not incur. In connection with the settlement, which was approved by U.S. District Judge Lewis A. Kaplan on May 14, 2015, the defendant agreed to pay a total of $18,800,000 to resolve its liabilities, and made admissions as to its conduct.

Read the full press release, including details regarding the relationships that were found to be problematic, here.

May 8, 2015

Blog Welcomes Young Lawyers' Committee

The NYSBA Health Law Section recently established a Young Lawyers' Committee for members who were admitted less than ten years ago. The committee supports members who are establishing themselves in the health law profession, as well as those in other fields who are interested in exploring health law. Members of the committee will soon begin contributing to this blog.

Check the blog for posts tagged as "young lawyers," and please comment. Notes of encouragements and questions for young lawyer contributors would be welcome!

April 29, 2015

Trinity Health to Acquire St. Joseph's in Syracuse

Healthcare Dive is reporting that Trinity Health has struck a definitive agreement to acquire Syracuse, NY-based St. Joseph's Hospital Health Center. Read the brief here.

February 27, 2015

Albany Medical Center Boasts BP Success

Yesterday's Albany TimesUnion covers the payoffs from Albany Medical Center's focused effort on controlling hypertension in its patients.

A concentrated effort among all Albany Medical Center physicians to monitor hypertension has continued to increase the number of patients there who are keeping their blood pressure in check, the health system reported Thursday.

Albany Med patients are nearly twice as likely to have their high blood pressure under control than all Americans who have hypertension, a result attributed to a program developed more than two years ago.

Read the rest of the article here.

February 26, 2015

An Interesting Take on AKS Referrals

Here's a clip from a National Law Review article from Tuesday, February 17:

On Feb.10, 2015, the U.S. Court of Appeals for the Seventh Circuit expanded the definition of "referral" under the Anti-Kickback Statute (AKS) by holding that a referral under the AKS is found when a provider authorizes a patient for specialist treatment even if the provider does not recommend a certain specialist.

Read the full article here.

February 25, 2015

Governor's Effort to Take Down NY Doc Profiles Causing a Stir

Modern Healthcare covers a dustup over Governor Cuomo's proposal to save some money by doing away with the Department of Health's Doctor Profile website.

New York Gov. Andrew Cuomo's proposal to save $1.2 million by defunding the state's NYDoctorProfile.com website is coming under fire from a coalition of 16 patient- and consumer-advocacy groups who call the plan "a dangerous step backwards in the effort for greater transparency in healthcare."

Read the rest of the article here.


Montefiore Profiled as Care Management Reimbursement Model

There is a lengthy laudatory writeup in Capital New York on Montefiore Medical Center's success with the care management reimbursement model:

In a care management model, a health system like Montefiore receives a certain portion of the insurance premium regardless of how much, or the type of care it provides. If Montefiore can keep that person healthy for less than the premium, it keeps the difference. If it can't, it eats the loss.

These arrangements provide both risk and opportunity for health systems in ways that have never before existed.

So far, Montefiore has been one of the nation's success stories.

It was one of only 32 health systems in the nation--and the only one in the state--to join the Pioneer Accountable Care Organization, a pilot Medicare savings program created by the Affordable care Act. The health system reported saving Medicare $24.5 million in its first year, utilizing some of the same strategies on thousands of patients that it does on Pratt.

See the entire article here.

February 11, 2015

U.S. Government Establishes Cyber-Security Center

Cyber-security is all the news these days. Yesterday's Washington Post carried an article announcing a new federal Cyber Threat Intelligence Integration Center.

The Obama administration is establishing a new agency to combat the deepening threat from cyberattacks, and its mission will be to fuse intelligence from around the government when a crisis occurs.

The agency is modeled after the National Counterterrorism Center, which was launched in the wake of the Sept. 11, 2001, attacks amid criticism that the government failed to share intelligence that could have unraveled the al-Qaeda plot.


Read the full Post article here.

February 10, 2015

NY Department of Financial Services Produces Report on Cyber-Security in the Insurance Industry

Although probably not planned that way, the February 8 release of a report on cyber-security by the New York Department of Financial Services could not be better timed to the recent Anthem breach. Here is a snippet from the Department's press release:

Benjamin M. Lawsky, Superintendent of Financial Services, today announced the release of a Department of Financial Services (DFS) report on cyber security in the insurance industry and a series of measures that DFS will take to help strengthen cyber hacking defenses at insurers. To view a copy of the report, please visit, link.

In the coming weeks and months, DFS will integrate regular, targeted assessments of cyber security preparedness at insurance companies as part of the Department's examination process; put forward enhanced regulations requiring institutions to meet heightened standards for cyber security; and examine stronger measures related to the representations and warranties insurance companies receive from third-party vendors, among other measures.

Read the entire press release here, or skip right on ahead to the report.

February 9, 2015

Senior Health Partners Notifies 2,700 of Data Breach

From a February 3 article in HealthcareIT News:

A New York healthcare provider is notifying its patients that their medical data has been compromised after one of its business associates reported the theft of an employee-owned laptop and unencrypted smartphone.

The New York-based Senior Health Partners, part of the Healthfirst health plan, has mailed out breach notification letters to 2,700 of its members after discovering that a laptop and mobile phone belonging to a registered nurse employed by its business associates were reported stolen.

Read the full article here.

February 6, 2015

Anthem Data Breach Hits Closer to Home

Reported Wednesday afternoon and widely covered Thursday, news of Anthem's 80 million member data breach went coast-to-coast. Today's Times Union details some of the potential impact in New York:

Tens of thousands of Capital Region residents who have medical coverage with Anthem/Empire Blue Cross, the state's Empire Plan, or the NYSHIP Empire Blue Cross/Blue Shield HMO may have had personal information stolen in a major data breach.

Read the full article here.

A Bloomberg report indicates early signs point towards Chinese state sponsorship of the hack.

Investigators of Anthem Inc.'s data breach are pursuing evidence that points to Chinese state-sponsored hackers who are stealing personal information from health-care companies for purposes other than pure profit, according to three people familiar with the probe.

See the Bloomberg article with an accompanying video.

February 5, 2015

Republicans Finally Muster a Counter to the Affordable Care Act

After five years of busily passing symbolic legislation repealing the Affordable Care Act, Republicans in Congress have at long last come up with an alternative proposal, covered here by the New York Times:

Three influential Republican members of Congress unveiled a comprehensive proposal on Wednesday to replace President Obama's health care overhaul with an alternative that would halt the expansion of Medicaid and scale back subsidies for middle-income people to buy private insurance.

The plan, drafted with encouragement from Republican leaders in the Senate and the House, would retain some consumer protections in the Affordable Care Act, but would reduce federal regulation of insurance policies. States would have more authority to specify the "essential health benefits" that must be provided by insurance. As an example, the federal government would no longer require insurance policies to include coverage for maternity care.

Read the full article here.

Without commenting on the merits of the Republican proposal, the fact that there is at least some kind of alternative plan to discuss will be helpful to reform as a whole. It will spark new ideas and directions for health reform, or it will solidify the position of the ACA and dispel some of the misgivings, either of which advances the discussion. Until now, the Republican position on health reform has largely been: "I don't know, just not the Affordable Care Act."

Governor Proposes More Taxes on Health Insurance Premiums

James Mulder at Syracuse.com covers this gem:

Gov. Cuomo's proposed budget would slap a new tax on health insurance premiums to help pay the cost of running the state's health insurance exchange.

The tax is $25, applies to on- and off-exchange policies, and is projected to add $69 million to the cost of acquiring health insurance. Read the article here.

February 3, 2015

1199SEIU Workers Authorize Strike

From a January 22, 2015 1199SEIU press release:

After months of unsuccessful efforts to reach a contract settlement, nursing home workers voted by 95 percent to authorize a strike. The contract negotiations cover over 8,000 caregivers in for-profit nursing homes in New York City and on Long Island. The nursing home workers are members of 1199SEIU, the city's largest healthcare union.

Read the press release here.

January 20, 2015

NY AG Schneiderman Looks to Bolster State Privacy and Security Laws

New York Attorney General Eric Schneiderman has called for an upgrade to the state's information security and privacy laws, according to a press release issued by the AG's office January 15th.

Given the prevalence and increase of data breaches over the past several years, it is clear that New York - and the United States as a whole - is in need of progressive legislation to protect consumers and businesses.

The AG intends to make New York's data protection laws the strongest in the nation.

For additional posts, see the archive headings in the right hand column.