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Publications
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02.13.2023New CMS Rule Requires Extrapolation of Medicare Advantage RADV Audit FindingsUpdates
The Centers for Medicare and Medicaid Services has codified regulatory changes to its Medicare Advantage Risk Adjustment Data Validation audit program of risk adjustments submitted by Medicare Advantage Organizations. Most significantly, CMS will begin applying contract-level extrapolation to its RADV audit findings beginning with audits of calendar year 2018, which will significantly increase MAO exposure based upon alleged overpayment findings.
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04.29.2020Congress and HHS Make Additional $170 Billion Available to Healthcare Providers to Address COVID-19 Testing, Treatment, and LossesUpdatesIn recent days the federal government has taken two significant steps to increase healthcare funding to assist providers in responding to the medical and economic consequences of the novel coronavirus pandemic.
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03.31.2020Healthcare Industry Implications of the CARES ActUpdatesThe Coronavirus Aid, Relief, and Economic Security Act, known as the “CARES Act,” became law on March 27, 2020. The CARES Act implements wide-ranging changes to law and funding designed to ameliorate the coronavirus pandemic’s impact on the American economy and its workers.
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03.23.2020Healthcare Industry Implications of the Families First Coronavirus Response ActUpdates
By a vote of 363-40 the U.S. House of Representatives passed H.R. 6201, the Families First Coronavirus Response Act, on March 14, 2020. The bill now proceeds to the U.S. Senate, and the White House has voiced its support for the legislation.
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03.09.2020AseraCare Settlement Ends Medical Judgment False Claims Act Case With a WhimperUpdatesThe U.S. Department of Justice (DOJ) has reached a settlement with hospice company AseraCare, closing a 12-year-old saga that carries substantial implications for False Claims Act (FCA) enforcement in cases involving a clinician’s medical judgement.
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12.17.2018Belated Government Dismissal of False Claims Act Cases: DOJ Maneuvering in Post-Escobar and Granston Memo EraUpdates
On November 30, 2018, the solicitor general filed an amicus brief in the U.S. Supreme Court supporting the relators’ opposition to certiorari in Gilead Sciences, Inc. v. United States ex rel. Campie, et al., No. 17-936. Yet the government’s brief disclosed for the first time that it would dismiss the relators’ qui tam complaint on remand, allegedly because discovery would interfere with federal agency responsibilities.
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08.14.2017Ninth Circuit Raises Bar for Approving Changes in State Medicaid ReimbursementUpdatesThe U.S. Court of Appeals for the Ninth Circuit Court raised the bar last week for what states must prove to establish that their Medicaid provider reimbursement rates are sufficient to ensure a robust network of providers for Medicaid beneficiaries.
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09.22.2015Pharma and Medical Device Industry Victory in Off-Label Marketing DecisionUpdatesThe U.S. District Court for the Southern District of New York recently held that the FDA may not constitutionally bring a misbranding action based on truthful and non-misleading off-label promotion of an FDA-approved drug, thereby helping to clarify lingering uncertainty over the scope of First Amendment protection afforded statements by drug representatives, at least in states located in the Second Circuit.
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03.02.2015Supreme Court Strikes Down State Professional Boards’ Antitrust ImmunityUpdatesIn a ruling with significant implications for state professional licensing boards and their members, on February 25, 2015, the United States Supreme Court found that practitioner-controlled state boards do not have inherent immunity from federal antitrust liability if they operate without active supervision by disinterested state actors.
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05.2012Idaho’s Peer Review Privilege - Lessons LearnedArticles
The Advocate
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2011Dancing Around Daubert: The Idaho Supreme Court’s Puzzling Approach to Expert TestimonyArticles
Idaho Law Review
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2009Why Researchers Might Have a Legal Duty to Disclose Individual Research Findings to Research SubjectsArticles
Food & Drug Law Journal
Presentations
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12.13.2023
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06.07.2023Demystifying Washington State’s My Health, My Data ActWebinarsThe recently enacted My Health, My Data Act (MHMD) will regulate the collection, use, sharing, analysis, and sale of health-related data of individuals in Washington state and beyond.
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11.03.2018Fraud and Abuse UpdateSpeaking Engagements
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11.04.2016Fraud and Abuse UpdateSpeaking EngagementsWashington Society of Healthcare Attorneys Fall Health Law Conference / Vancouver, B.C.
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04.29.2016Pharmacy and Controlled Substances RegulationSpeaking EngagementsWashington Society of Healthcare Attorneys Spring Health Law Conference / Seattle, WA
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10.19.2015The Physician Payment Sunshine Act: A Primer for the Life Sciences and Health Care IndustriesSpeaking EngagementsSociety of Research Administrators International Annual Meeting / Las Vegas, NV
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03.26.2014Ethical Pitfalls When Contacting Former EmployeesSpeaking EngagementsIdaho State Bar Employment Section / Boise, ID
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02.19.2014Protect Your Neck: Intellectual Property for Wine ProducersSpeaking EngagementsIdaho State Wine Commission Annual Meeting / Boise, ID
