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Delaware Health Law Blog

Written by Melony Anderson on August 6, 2024

Physical Therapist/Athletic Trainer Statute’s Prohibition Against Fee-Sharing with Physicians Declared Unconstitutional

On July 26, 2024, Judge Sheldon Rennie of the Delaware Superior Court held that 24 Del. C. §2616(a)(8) was unconstitutional.  The case is Kathy Callaway, PT, CHT, and Randeep Kahlon, MD v. Delaware Examining Board of Physician Therapists and Athletic Trainers, C.A. No. N23C-05-196 (Del. Super. Ct. July 26, 2024).   24 Del. C. §2616(a)(8) […]

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Written by Adam Balick on November 21, 2023

CMS Expands Ownership Disclosure Requirements for Skilled Nursing Facilities

On November 17, 2023, The Centers for Medicare & Medicaid Services announced a final rule requiring skilled nursing facilities to publicly disclose additional ownership and management information.   The new rule is specifically intended to require disclosure of private equity and real estate investment trust ownership, as well as those with management and financial control.   The […]

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Written by Adam Balick on March 2, 2023

$8.5 Million False Claims Act Settlement to Resolve Simultaneous Surgeries Action

It has been a while since we posted on this blog.   But an important False Claims Act case was settled this week.   This is a case that health care providers should be aware of, especially any provider that could be accused of over-scheduling procedures. The case was filed by a whistleblower against the University of […]

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Written by Nate Trexler on April 13, 2016

Medicare Overpayment Rule: Part 2 – Proactive and Reactive Compliance

This blog is the second post in a series discussing the Centers for Medicare and Medicaid Services’ Final Rule regarding the obligation to report and return Medicare overpayments. The first post discussed the basic requirement to report and return Medicare overpayments and two highlights of the rule—when an overpayment is “identified” and the 6-year lookback period. The first post can be viewed here. In this post, we discuss the impact of the rule on providers’ compliance initiatives (or lack thereof).

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Written by Nate Trexler on February 24, 2016

CMS Issues the Final Rule on Providers’ Obligation to Report and Return Overpayments

On February 12, 2016, the Centers for Medicare and Medicaid Service (“CMS”) published a final rule regarding the Affordable Care Act’s requirement that providers report and return overpayments. It has been a long road to this point. Back in 2012, we wrote about CMS’ proposed rule, which introduced quite a bit of uncertainty in the process of investigating overpayments and ultimately reporting and returning those overpayments. After nearly four years, and after considering approximately 200 pieces of commentary from interested parties, CMS has finalized the rule, further outlining provider responsibilities under the Affordable Care Act’s requirement.

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Written by Joanne Ceballos on February 4, 2016

Delaware Dental Board Proposes “Fee-Splitting” Prohibition

The Delaware Board of Dentistry and Dental Hygiene is proposing an amendment to its regulations to ban what it characterizes as “fee-splitting.” The proposed amendment provides that a dentist or dental hygienist may be disciplined for “engaging directly or indirectly in the provision or receipt of anything of value for recommending a dentist or hygienist’s services.” The proposed regulation, however, permits the offering or receipt of “office gifts” on a quarterly basis if the value of the gifts does not exceed $1,000 annually and the gifts are “unrelated to a specific referral.” As the federal and state Anti-Kickback statutes generally prohibit offering or receiving anything of value in exchange for the referral of federal or state health care program business, dentists who provide services payable by federal or state health care programs cannot rely solely on the proposed state regulation as a guideline for permissible gift-giving.

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Written by Nate Trexler on January 27, 2016

New Stark Law Exception for Sharing Space and Equipment

Physicians often ask about sharing space or equipment with colleagues. For a number of reasons, regulatory compliance often makes the proposed arrangement impractical, if not impossible. However, a new Stark exception will, for the first time, permit space and equipment sharing without having to satisfy the sometimes onerous and impractical lease requirements.

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Written by Joanne Ceballos on January 21, 2016

GAO Analyzes Connection Between Hospital-Physician Consolidation and Increased Medicare Spending for Evaluation and Management Services, Recommends Equalizing Rates for E/M Services in Office and Hospital Outpatient Settings

On December 21, 2015, the United States Government Accountability Office (GAO) issued a report entitled, “Increasing Hospital-Physician Consolidation Highlights Need for Payment Reform.” The GAO’s study was prompted by an inquiry from lawmakers about the more than 8 percent rise in Medicare expenditures for services rendered in hospital outpatient departments (HOPD) between 2007 and 2013, as compared to a 5 percent increase in total Medicare Part B spending during the same time frame.

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Written by Joanne Ceballos on December 11, 2015

Federal Trade Commission Issues Guidance on How State Licensing Boards May Avoid Antitrust Scrutiny

Earlier this year DE Health Law reported on a decision by the U.S. Supreme Court, North Carolina State Board of Dental Examiners v. Federal Trade Commission, holding that a state professional licensing board could be liable under federal antitrust laws for engaging in anticompetitive behavior in the absence of “active supervision” of the board by the state.

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Written by Joanne Ceballos on September 4, 2015

Five Years Post-Bradley

Five years ago, on September 1, 2010, one of the nine “Bradley” bills, House Bill 459, took effect in Delaware. Among other things, this bill clarified the obligations of hospitals to report any disciplinary action affecting a physician’s privileges, the obligations of law enforcement to report unprofessional conduct by a physician, and that a physician’s failure to report unprofessional conduct of another physician is itself unprofessional conduct. Subsequent legislation incorporated “failure to report” into the definition of “unprofessional conduct” applicable to other health care professionals as well.

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