A recent decision from the Ninth Circuit Court of Appeals in DB Healthcare, LLC v. Blue Cross Blue Shield of Arizona, Inc., No. 14-16518, 2017 WL 1075050 (9th Cir. Mar. 22, 2017) reaffirms that health care providers are not health plan “beneficiaries” with the ability to sue under ERISA. Health care providers may sue under ERISA’s civil enforcement provisions only when armed with robust assignments of benefits and rights from patients and where the governing Plan documents do not prohibit assignments.
On March 28, 2017, the Centers for Medicare and Medicaid Services (CMS) posted a revised Voluntary Self-Referral (Stark) Disclosure Protocol (SRDP), which replaces the prior version of the protocol. Under the Affordable Care Act (ACA), providers generally must return overpayments within 60 days after identification (the 60 Day Rule), and the SRDP is one of the primary tools that providers can use to return overpayments caused by an actual or potential violation of the Stark Law. The revised protocol now requires information to be submitted on detailed Disclosure, Physician Information, and Financial Analysis Worksheet forms, along with a Certification. A supplemental cover letter is optional.
* The following article was originally published by California Healthcare News. To read it on the California Healthcare News website, click here.
On March 27, 2017, Rachel Yount attended the Health Care Compliance Association’s Compliance Institute 2017, where Illiana Peters, a senior advisor at Health and Human Services, Office for Civil Rights (“OCR”), provided an “OCR Enforcement Update.”
A recent decision from the Fourth Circuit Court of Appeals in Beck v. McDonald, 848 F.3d 262 (4th Cir. 2017), adds to the list of circuit courts of appeal that have held that that the mere threat of future harm resulting from a data breach, without more, is insufficient to satisfy the injury-in-fact requirement for Article III standing.
In a Federal Register notice scheduled to be published on March 20, 2017, the Health Resources and Services Administration (HRSA) announced that it will delay the effective date of the January 5, 2017 final rule (the Final Rule) that provided guidance on the calculation of drug ceiling prices and the imposition of civil monetary penalties on certain drug manufacturers participating in the 340B Drug Pricing Program. Arent Fox’s Health Care Counsel Blog previously featured an analysis of the Final Rule, which can be found here.
In a report released on March 9, 2017, a National Academies of Sciences, Engineering, and Medicine committee concluded that the bioeconomy is growing rapidly and the US regulatory system needs to provide a balanced approach to the many competing interests that will arise in the face of the expansion. The Committee also noted that regulators should be prepared for a broad array of new types of biotechnology products.
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