Category: Health Law Highlights

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Health Law Highlights

American College of Physicians Issues Policy Position Paper on AI use in Health Care

Summary of article from Dermatology Advisor, by Colby Stong:

The American College of Physicians (ACP) has released a policy position paper detailing 10 recommendations for the use of artificial intelligence (AI) and machine learning in healthcare. The ACP emphasizes that AI should complement rather than replace physicians’ decision-making and should adhere to medical ethics principles. It advocates for transparency, privacy, and continuous improvement in AI applications, as well as accountability from AI developers. The ACP also suggests AI tools should reduce clinician burden and that all levels of medical education should include AI training. Lastly, the ACP calls for research into the environmental impact of AI.

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Health Law Highlights

Humana Can Challenge Medicare Clawback Rule

Summary of article from Reuters, by Brendan Pierson:

Humana can proceed with its lawsuit against a Biden administration rule that enables Medicare to reclaim overcharges from insurers. The rule, established in January 2023, permits the government to recoup payments to Medicare Advantage plans when audits reveal charges for diagnoses not present in patients’ medical records. The Biden administration believes this could help recover around $4.7 billion over a decade. Humana argues the rule is “arbitrary and capricious,” with potential unforeseen consequences for Medicare Advantage organizations and beneficiaries. The judge rejected the administration’s request to dismiss the case, stating that the perceived risk of future harm was enough to establish standing.

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Health Law Highlights

HHS Must Take Immediate Action to Improve Cybersecurity at Large Healthcare Organizations

Summary of article from The HIPAA Journal, by Steve Adler:

Senator Ron Wyden has called on the Department of Health and Human Services (HHS) to take immediate action against large healthcare companies to strengthen their cybersecurity practices. He has criticized HHS for its lack of regulation and oversight, particularly in light of recent cyberattacks on major healthcare organizations, such as Change Healthcare and Ascension. Wyden has recommended the development and enforcement of minimum cybersecurity standards for systematically important entities (SIEs), including resilience to cyberattacks and business continuity. He also suggested that the HHS should stress test SIEs and prioritize their audits. Moreover, he has urged HHS to provide technical assistance and guidance to smaller healthcare organizations through the Centers for Medicare & Medicaid Services (CMS)’s Quality Improvement Organizations and Medicare Learning Network programs.

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Health Law Highlights

Avoiding HIPAA Penalties: A Checklist for Covered Entities

Summary of article from Holland & Hart, by Kim Stanger:

The Health Insurance Portability and Accountability Act (HIPAA) applies to healthcare providers, healthcare clearinghouses, and health plans, enforcing rigorous privacy, security, and breach notification rules. Non-compliance can lead to severe civil and criminal penalties, with a tiered penalty structure based on the severity and nature of the violation. While there isn’t an explicit private cause of action for injured individuals under HIPAA, claims can be made under negligence or common law. To ensure compliance, entities should assign HIPAA responsibility, understand use and disclosure rules, implement and maintain written policies, execute appropriate business associate agreements, and stay updated with changes in regulations.

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Health Law Highlights

Texas Nursing Homes Face Continued Staffing Shortages, Low Ratings

Summary of article from Community Impact, by Sarah Hernandez:

In 2022, the median turnover rate for registered nurses and licensed vocational nurses in long-term care facilities exceeded 50%, according to the Texas Center for Nursing Workforce Studies. This increase is attributed to exhaustion after the pandemic, with long-term care proving more demanding than acute hospital settings. Texas received the lowest ranking for nursing home conditions from advocacy group Families for Better Care. In response, new rules from the Centers for Medicare and Medicaid Services aim to improve care quality by mandating minimum staffing requirements. However, the Texas Center for Nursing Workforce Studies and industry professionals suggest this is unrealistic without strategies to improve staff retention and recruitment, such as pay increases and educational partnerships.

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Health Law Highlights

Kickbacks and Medically Unnecessary Treatments: Five Major Qui Tam Settlements from May 2024

Summary of article from Kohn, Kohn & Colapinto LLP, by Geoff Schweller:

In May, the U.S. Department of Justice (DOJ) and U.S. Attorneys’ Offices announced several substantial settlements under the False Claims Act (FCA), resolving qui tam whistleblower lawsuits related to healthcare fraud. The settlements involved cases of kickbacks, billing for unnecessary treatments, and non-compliance with Medicare rules. Prominent cases included a $27 million settlement with Daniel Hurt for alleged Medicare fraud, a $24.3 million settlement with Cape Cod Hospital for non-compliance with Medicare rules, and a $12 million settlement with Innovasis Inc. for alleged kickbacks to surgeons. Other notable settlements involved RiverSpring and Elara Caring, which settled for $10.1 million and $4.2 million respectively. These settlements underscore the importance of whistleblowers in combating healthcare fraud, and highlight the significant financial burden and potential harm caused by fraudulent practices.

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Health Law Highlights

AI in the Health Insurance Industry: An Explainer and Research Roundup

Summary of article from The Journalist’s Response, by Rachel Layne:

As artificial intelligence (AI) becomes increasingly prevalent in health insurance, U.S. states are seeking to regulate its use due to concerns of racial bias and flawed coverage determinations. Major health insurers like Humana, Cigna, and UnitedHealth face lawsuits over alleged improper use of AI in coverage decisions. Various state and federal initiatives aim to increase transparency around AI systems’ creation, data inputs, and decision-making algorithms. The National Conference of State Legislatures reports that at least 40 states have introduced or passed AI-regulating legislation in 2024, with many states modeling their regulations on guidance from the National Association of Insurance Commissioners. However, the varying rules across states could pose challenges for insurers.

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Health Law Highlights

3 Ways AI Can Improve Revenue-Cycle Management

Summary of article from American Hospital Association:

The integration of artificial intelligence (AI) and automation can enhance revenue-cycle management (RCM) in healthcare, reducing costs and boosting efficiency. AI applications in RCM include automated coding and billing, predictive analytics for denial management, revenue forecasting, patient payment optimization, data security, and operational efficiency. Case studies demonstrate that AI can lead to significant improvements in RCM, such as reducing denials, increasing productivity, and improving financial outcomes. However, the adoption of AI also carries risks, requiring careful data structuring to prevent bias and validation of AI outputs. The adoption of AI in healthcare is expected to grow in the coming years, with initial focus on simpler tasks and gradually expanding to more complex aspects of RCM.

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Health Law Highlights

Privacy Abuses Will Meet ‘Full Force of the Law’ From New Texas Unit, Attorney General Says

Summary of article from The Record, by Joe Warminsky:

Texas Attorney General Ken Paxton has announced the formation of a new data-privacy team within the consumer protection unit of his office. The team will enforce Texas privacy laws, focusing on data privacy and security, identity theft, data brokers, biometric information, consumer protection, and federal laws covering children’s privacy (COPPA) and healthcare information (HIPAA). The Texas Data Privacy and Security Act, a consumer-friendly law, will come into effect on July 1. Paxton has stated that companies exploiting consumer data will face legal consequences. This move is in line with several states, like Vermont, implementing broad privacy laws as federal regulation remains in limbo.

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Health Law Highlights

Lessons Learned From Walmart, Amazon, and Walgreens: Healthcare’s Retail Reset

Summary of article from D Magazine, by Will Maddox:

Walmart, Amazon, and other major corporations have struggled to make a profitable venture into primary care, often citing high operating costs and reimbursement challenges. Retail healthcare has proven complex due to the transient nature of providers in these settings and the difficulty in maintaining long-term patient relationships. Further, the current fee-for-service model in healthcare is unsustainable. The ongoing shortage of physicians is a significant challenge. A new payment model could alleviate the shortage and better meet the growing demand for primary care.