10 Takeaways from the AHLA Annual Meeting

One of our favorite sessions at the AHLA Annual Meeting is the Year-in-Review by Jack Schroeder and Elizabeth Carder-Thompson. It is a great way to get caught up on a year’s worth of activity in health law in 120 minutes. Out of the volumes of information Jack and Elizabeth read to summarize for conference attendees, we found 10 pieces of information that were particularly interesting for our practice in these days of constant and rapid change. We felt these would be worth sharing:

  1. 638 qui tam cases were filed during FY 2015, resulting in settlements of $2.8 billion. Healthcare settlements amounted to $1.9 billion in federal dollars, with hospitals making up $330 million of the number.
  2. Qui tam relators included physicians, CFOs, sales reps, and former administrators.
  3. The “Yates Memo” of September 9, 2015 on individual accountability for corporate wrongdoing in 2015 shows the DOJ intent to pursue and prosecute more individuals for corporate malfeasance. Since the Yates Memo, former health care executives have faced trials.
  4. In Universal Health Services v. Escobar, the U.S. Supreme Court (SCOTUS) decided on the implied certification theory for FCA cases. SCOTUS rejected the express condition of payment, but added a materiality requirement.
  5. The OIG issued a new alert and a nationwide analysis on common characteristics in OIG home health fraud cases, demonstrating its emphasis on fraud in the home health industry.
  6. Large settlements between the U.S. and hospital systems in September 2015 focused on employed physician where fair market value of physician compensation and/or commercial reasonableness of physician employment arrangements were significant issues.
  7. In May 2016, CMS issued a significant proposed rule related to MACRA, which repealed the much maligned sustainable growth rate formula and implemented MIPS and APM reforms.
  8. CJR is a mandatory joint replacement bundle payment initiative required for hip and knee replacements in 67 geographic areas. CMS expects to see savings of $343 million.
  9. Healthcare is the number one industry subject to hacking. Some risks include hacking of infusion pumps to manipulate them to change patient dosages, setting defibrillators to deliver random shocks to patients, resetting temperatures on refrigerators to cause spoilage of blood and drugs, and altering patient records.
  10. Among the consolidation in the market, mergers among payers are increasing. 2015 was a banner year for healthcare mergers and acquisitions.

Listening in on the Year-in-Review is a treat that Annual Meeting attendees do not take for granted. It reminds us that this industry is in a constant state of flux and to remain relevant, we must all remain in touch with current developments.


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Topics: Electronic Health Records, Hospital Acquisition

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