We have previously reported that a number of states have proposed legislation to address growing concerns about the potential negative impacts of private equity (PE) investments in healthcare businesses. Vermont has now joined this list by passing legislation on June 15 (H.583, “An act relating to clinical decision making”) that imposes significant limitations
Overview of the Federal IDR Process
[Note: On May 28, HHS finalized new regulations on the IDR process, as discussed here.]
The No Surprises Act (NSA), enacted in 2020, was designed to protect patients from unexpected medical bills in certain healthcare settings. The law primarily applies when a patient receives emergency care at either an in-network or out-of-network facility, or
Understanding Medicare Revalidation Requirements
In accordance with 42 C.F.R. § 424.515, all healthcare providers participating in Medicare are required to periodically revalidate their enrollment records with the Centers for Medicare & Medicaid Services (CMS) in order to maintain Medicare billing privileges. This routine process requires providers to confirm and, if necessary, update their enrollment information.
Revalidation generally occurs every
Navigating the Use of Peptides in Medical Spas
Medical spas continue to expand beyond traditional aesthetic services, and peptides have quickly become one of the more heavily marketed offerings in this space. While these products are often positioned as part of a broader “wellness” model, the legal framework that governs them is far less flexible.
At the federal level, the key issue is
Examining the Role and Impact of Private Equity in Healthcare – A Comprehensive Analysis
A recent report issued by The NYU Stern Center for Business and Human Rights entitled “Private Equity and Healthcare: Balancing Profit with Wellness” examined the expanding role of private equity in the healthcare sector, concluding that “Private Equity’s combination of legal immunity, public anonymity, and financialized ownership creates a culture that often prioritizes profits over
FTC Forms Task Force to Investigate Healthcare Transactions, Deceptive Marketing
On March 20, the Federal Trade Commission (FTC) issued a memorandum announcing the formation of a Healthcare Task Force dedicated to addressing unlawful business practices within the healthcare sector. The memorandum emphasizes that industry consolidation and anticompetitive conduct have contributed to “higher prices, decreased quality, less access and transparency, and stifled innovation.” According to the FTC
New York Amends Shield Law
The New York “Shield Law” refers to several statutes intended to protect patients and providers seeking or offering services concerning gender-affirming care or abortion. These statutes were enacted in response to certain other states increasingly criminalizing these types of healthcare services. The Shield Law prohibits state cooperation with hostile actions, prevents the forced production of
NY Doctor Sentenced in TCD Kickback Scheme
A New York physician was recently sentenced in federal court for receiving kickbacks in exchange for ordering medically unnecessary brain scans. Vishnudat Seodat of Mattituck had practiced for 36 years and operated three “New York Health” offices on Long Island. He announced his retirement in a letter to patients last month.
From 2013 to 2019
OIG Report Exposes “Ghost Networks” Across U.S.
The New York Attorney General’s Office imposition of a $250,000 penalty on MVP Health Care for maintaining an inaccurate mental health provider directory riddled with “ghost” providers was recently discussed here. The problem, however, extends beyond New York. The U.S. Department of Health and Human Services’ Office of Inspector General (OIG) recently issued a
Medicare Telehealth Flexibilities Expire
As of September 30, several temporary Medicare telehealth flexibilities that were put in place during the COVID-19 pandemic officially came to an end. One of the most significant changes involves the site requirement for telehealth services. Medicare beneficiaries can now only receive telehealth services other than behavioral or mental health services from specific originating sites