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FMV for Provider Contracts: Regulatory Standards
/in Anti-Kickback, StarkBy Kim Stanger
As a general rule, healthcare employers are required to pay employed physicians and other contracted providers fair market value (FMV) for their services, but many employers do not understand relevant regulatory standards. In this health law update, we summarize Stark and Anti-Kickback Statute considerations.
I. STARK (PHYSICIANS AND PHYSICIAN FAMILY MEMBERS).
The federal Ethics in Patient Referrals Act (aka Stark) prohibits physicians1 from referring certain designated health services (DHS)2 payable by Medicare or Medicaid to entities with which the physician or a family member of the physician has a financial relationship unless the arrangement is structured to fit within a statutory exception or regulatory safe harbor.3 Violations may result in significant penalties.4 Read more
Idaho’s New Parental Consent Law: FAQs
/in Idaho Healthcare LawBy Kim Stanger
Idaho’s new parental consent law took effect July 1, 2024. Under the new law:
“‘Minor child’ means an individual under eighteen (18) years of age but does not include an individual who is an emancipated minor.”3 Parents may sue healthcare providers and other individuals who violate the law.4 For more information about the law, see our articles at New Limits on Minor Consents in Idaho, Blanket Consents Under Idaho’s New Minor Consent Law, and Idaho’s New Parental Access Law v. HIPAA. In the meantime, here are my answers and, in some cases, my best guesses in response to common questions I receive concerning the law. Read more
Supreme Court Restores the EMTALA Exception to Idaho’s Abortion Ban for Now
/in EMTALA, Idaho Healthcare LawBy Kim Stanger and Cameron McCue
On June 27, 2024, the United States Supreme Court temporarily restored the Emergency Medical Treatment and Labor Act (EMTALA) exception to Idaho’s abortion ban. As a result, Idaho hospitals may perform abortions in EMTALA cases when necessary to preserve the health of the pregnant woman.
How We Got Here. In 2022, the United State Department of Justice (DOJ) brought a lawsuit challenging Idaho’s abortion statute in cases in which EMTALA applies. In August 2022, the federal District Court of Idaho entered a preliminary injunction that prohibited Idaho from enforcing its broad abortion ban in EMTALA cases pending resolution of the DOJ’s lawsuit. (See Order, available here: https://f.datasrvr.com/fr1/822/74681/Winmill-abortion-injunction-decision_(003).pdf). Idaho appealed to the 9th Circuit, which first lifted then restored the preliminary injunction. Idaho then sought immediate relief from the United States Supreme Court, which agreed to take the case and stayed the District Court’s injunction. However, last week, the Supreme Court changed its mind and, in a per curiam decision, concluded that it had improvidently agreed to take the case and sent the matter back to the lower courts for further proceedings. In so doing, the Supreme Court vacated its order staying the District Court injunction, thereby restoring the injunction, which effectively, if temporarily, allows Idaho hospitals to perform abortions in EMTALA cases. A copy of the Supreme Court’s decision is available here: https://www.supremecourt.gov/opinions/23pdf/23-726_6jgm.pdf. Read more
Court Vacates HIPAA Online Tracking Guidance
/in HIPAABy Kim Stanger
On June 20, 2024, a Texas federal court vacated the Office for Civil Rights’ (OCR’s) controversial guidance concerning Use of Online Tracking Technologies by HIPAA Covered Entities and Business Associates, available here. While providers will welcome the decision, the decision does not allow providers, business associates, or vendors carte blanche license to use or disclose protected health information (PHI) for purposes not permitted by HIPAA.
Read more
Avoiding HIPAA Penalties: A Checklist for Covered Entities
/in HIPAAby Kim C. Stanger
The HIPAA Privacy, Security, and Breach Notification Rules1 apply to healthcare providers who engage in certain electronic transactions, healthcare clearinghouses, and health plans, including employee group health plans with 50 or more participants or that are administered by a third party.2 Covered entities must comply with HIPAA for the following reasons:
1. Civil Penalties. The Office for Civil Rights (OCR) may—and in some cases must—impose civil penalties against covered entities and their business associates who violate HIPAA. The following chart summarizes the tiered penalty structure currently in effect; the penalties are subject to annual cost of living increases.3 Read more