Jade Smith, MJ, CCEP

𝐇𝐨𝐬𝐩𝐢𝐭𝐚𝐥 𝐫𝐚𝐭𝐞 𝐬𝐭𝐚𝐧𝐝𝐚𝐫𝐝𝐢𝐳𝐚𝐭𝐢𝐨𝐧: 𝐒𝐂 𝐬𝐞𝐭 𝐭𝐨 𝐝𝐞𝐥𝐢𝐯𝐞𝐫 𝐯𝐞𝐫𝐝𝐢𝐜𝐭 𝐭𝐡𝐢𝐬 𝐦𝐨𝐧𝐭𝐡 Supreme Court is set to deliver a verdict this month on standardizing fee structures for private hospitals. The proposed fees are based on the Clinical Establishment Rules of 2012. It is aimed to reduce patient bills and bridge the treatment cost gap between public and private institutions. However, the industry has cautioned that implementing uniform pricing will negatively impact the financial viability and further investments. #SupremeCourt #private #hospitals #standardizing #fee #bills #treatment #cost #institutions #investments #financial

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#DYK that the SST makes decisions on appeals relating to the #CPP, the #OAS Act, and the #EI Act? Learn more about the appeal process in our Rules of procedure: https://ow.ly/xhCS50RYBle #AccessToJustice #a2j

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Education or Self-Justification?: #OIG’s Latest #MA “Impact Brief” OIG has released a #MedicareAdvantage “Impact Brief” highlighting the results of its audit into inappropriate #priorauthorizations. But that audit took place in 2022. Why issue a summary now of a dated audit? The Charitable Interpretation: OIG has a legitimate—indeed, a core—interest in preventing #healthcarefraud and abuse. What better way than to leverage prior analyses? In this case, the 2022 audit found that MA plans denied over 1 million PAs and that 13% were, in reality, for medically necessary services. Based on that, OIG’s brief is addressing a serious issue, with a significant error rate*, that is clearly deserving of additional reeducation. The Not So Charitable Interpretation: The (political and enforcement) tides has turned against MA. Long-standing, simmering #Dem hostility for the program—leveraging concerns about #riskadjustment, “one way” #chartaudits, #AKS challenged incentive compensation arrangements with physicians, and other alleged practices—has broken through. That hostility, reflected in policy decisions such as a sea change in MA annual rate updates, is even more evident as an enforcement matter. #DOJ highlighted MA fraud as the single most important fraud and abuse issue in its 2023 YE #FalseClaimsAct summary, and #ChristiGrimm, the IG, did the same in her budget testimony to Congress. But, when program criticism takes hold like this, OIG, in particular, can find itself on the receiving end of questions, from Congress and others. What did you do to prevent these issues? Why didn’t you do more? Was this “impact brief” part of an effort to head off/address those inevitable questions? Bottom Line: So, Which Is It? Was this education or an act of self-defense—an attempt to do a little inoculation against the finger-pointing virus? I’m going with both. * #Managedcare defenders would hasten to underscore the flip side that OIG did not challenge 87% of reviewed PAs.

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#Medicalrecords play an important role at every stage of the #litigationprocess. #Medicalrecordreview is a major requirement. https://bit.ly/3QSwuM6

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Don’t miss this program, coordinated by Rita Garry, JD, CFP, CIPP/US and presented by the Illinois State Bar Association, that is designed to help demystify the Data Protection Addendum (DPA) and show you how to approach third party/vendor contracts involving personal data! Business advice/financial planning attorneys, corporate law counsel, privacy and security law lawyers, and legal technology practitioners with basic practice experience who attend this online program will better understand: - When a DPA is required; - What is involved in a DPA, including key terms and requirements (from both a data controller and data processor perspective); - The policies and procedures required to supplement DPA promises; - The new technologies that impact DPAs and require special considerations; - The legal landscape governing contracts involving “personal” data, including U.S. and international differences; - When to escalate issues to privacy professionals; and - Much more. Register for the webcast below: https://bit.ly/3UjepcU

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Our latest blog discusses the Michigan Supreme Court's recent amendment to Rule 702 of the Michigan Rules of Evidence, effective May 1, 2024, which introduces certain requirements for proponents of expert witnesses in trials. Click below to read more. FMG authors: Josh Zhao and Jonathan Schwartz #FMG #FMGlaw #expertwitness #Michigan #FederalRulesofEvidence

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In a highly-anticipated shift in federal drug policy, the U.S. Drug Enforcement Agency (DEA) recommended the reclassification of marijuana from Schedule I to Schedule III under the Controlled Substances Act on April 30. While the change (if approved) will lead to more flexibility in some instances, federally-funded organizations such as health centers and research institutions should remain cognizant of important legal restrictions.   Feldesman Partners Molly Evans and Mindy Pava comment on how this changing legal landscape will impact health centers and other federal grantees in their client alert here: https://lnkd.in/dmF4w9nz   Additionally, Ms. Evans and Ms. Pava will host the webinar “Navigating the Haze: Marijuana and Changes to Federal Law” on May 29 at 1 p.m. to review the DEA’s decision and its implications. Register here: https://lnkd.in/d5y_WN_m #Feldesman #federalgrants #healthcenters #marijuana #research

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What is a stenographer, and how can one benefit you in court? 💭 A stenographer is trained to type or write in shorthand, allowing them to capture speech as quickly as it happens. By working with this professional, you'll receive: ✅ Accurate documentation ✅ Error-free transcripts ✅ Clearly written notes Have any questions? Drop them in the comments below 👇

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Thank you to Alisa McLellan and Abigail Mast for bringing together Women in eDiscovery - Chicago Chapter and the Chicago Chapter of Association of Certified E-Discovery Specialists (ACEDS) for a comprehensive presentation by Sara Davey on Bystander Training. For those who couldn't attend and are wondering how to support or intervene when witnessing harassment, think about: Delegate: Talk to a manager, bartender, or even call 911 if necessary Distract: Find a way to break up the moment or conversation. Direct: Directly intervene if safe to do so. Delayed: If you can't take action in the moment, check in later with the person and offer resources. Document: Write down what happened (or record if safe). Thank you to DISCO for sponsoring, and Perkins Coie LLP for hosting. Women in eDiscovery™ Perkins Coie LLP - E-Discovery Services & Strategy #ediscovery #legaltech #bystandertraining

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On June 10, 2024, the Supreme Court of the United States agreed to hear an appeal challenging the Disproportionate Share Hospital (DSH) reimbursement policy in the case of Advocate Christ Medical Center, et al v. Becerra. This appeal, brought by over 200 hospitals, disputes how the Centers for Medicare and Medicaid Services (CMS) calculates DSH payments. The Supreme Court's decision to review this case marks a hopeful turn for the 450 hospitals involved in the initiative and others who have raised similar concerns. The case centers on CMS's interpretation of the Medicare Fraction of the DSH payment formula, specifically the inclusion criteria for Supplemental Security Income (SSI) recipients. To dive deeper into this critical development, check out the full article on Healthcare Finance News here - https://hubs.ly/Q02D2SbC0.

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#Depositionsummaryservices is an important consideration when developing a medical negligence or #personalinjurycase. Attorneys need #depositionsummaries for case preparation, strategy development, and ultimately, successful litigation. https://bit.ly/4c17L0V

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Are you confused about Due Diligence? The Art Loss Register and FCS Compliance invites you to a free webinar on ‘Customer and Object Due Diligence: Managing Risk and Criminal Liability’ on Monday 20th May 5-6pm. We hope to see you there! James Ratcliffe, Director of Recoveries & General Counsel at The Art Loss Register will be co hosting the webinar alongside Rena Neville, Head of the Art Division at FCS Compliance and Paula Trommel, Head Advisor of the Art Division at FCS Compliance. More information and sign up here: https://lnkd.in/eTgyjFAQ #DueDiligence #Webinar #ArtLossRegister #FCSCompliance

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The recent decision in SCCY Industries, LLC v. Susan Romanov, FA 2093890 (FORUM May 8, 2024) is a reminder of the limited scope of ICANN’s Uniform Dispute Resolution Policy (UDRP). Complainant (a firearms manufacturer) and Respondent jointly marketed a handgun as a part of what was called the “Patriot Package” and Respondent registered the disputed <sccypatriot. com> domain name as a part of that effort. Complainant argued that it needs the domain name to market the next generation “Patriot” product. Respondent claimed that it had used the domain name as intended by the Parties’ agreement. The Panelist concluded that the Parties’ dispute could not be resolved under the UDRP: “[T]he scope of the procedure is limited, such that it is available only in respect of deliberate, bad faith, abusive, domain name registrations … and is not applicable to disputes between parties with competing rights acting in good faith.” Review the decision for more of the Panelist’s analysis: https://lnkd.in/gD2bpWwB #FeaturedDecision #ADR #Arbitration

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We have great news!!! U.S. Sentencing Commission voted to ban the use of acquitted conduct to calculate a guideline sentence! Judge Carlton Reeves, the Chair of the Commission, explained, “Not guilty means not guilty. By enshrining this basic fact within the federal sentencing guidelines, the Commission is taking an important step to protect the credibility of our courts and criminal justice system." You can read more from Mary Price, General Counsel, FAMM on their website. P.S. The proposed amendments were submitted to Congress on April 30, 2024, and will be added to the federal sentencing guidelines on November 1 unless Congress successfully modifies or rejects any of them. You can see all the amendments here: https://lnkd.in/e59dhbbP

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