On November 10, 2015, the Pennsylvania Superior Court ruled that a trial court did have the jurisdiction to issue fines related to overtime in healthcare facilities as specified by state law. In the case of Roman v. McGuire Memorial, a trial court reinstated and awarded back pay to a nurse fired in 2011 for refusing to work mandatory overtime. A 2009 state law (Act 102) prohibits healthcare employers from requiring employees to work more than predetermined, agreed-to, regular shifts, and at the time of her termination, the state’s Department of Labor and Industry had not issued any regulations around this act. Since there was no statutory remedy specified by either the law itself or by the agency for violations of Act 102, and there was no other means by which the plaintiff could seek redress, the Superior Court ruled that a trial court had jurisdiction over the matter.
On November 3, 2015, a federal judge ruled that Health and Human Services (HHS) did not exceed the scope of their authority by requiring physicians to submit detailed explanations, including documenting face-to-face meetings with patients, for their decisions to authorize home health services for Medicare beneficiaries. HHS previously mandated that providers submit these detailed narratives, but eliminated this requirement in November 2014. US District Judge Christopher R. Cooper’s ruling means that any Medicare claims filed by providers authorizing home health services before Nov. 2014 are subject to that requirement.
On October 26, 2015, the Federal Trade Commission (FTC) and the Department of Justice (DOJ) antitrust division issued a joint statement to Virginia regarding its “certificate of needs laws,” stating that these laws should be overhauled. Certificate of needs laws vary, but essentially they require that healthcare providers appeal to the state and demonstrate the necessity of expanding their facilities and services before these expansions are made. Both the FTC and DOJ determined that these types of laws do not necessarily raise the quality of services provided, nor do they necessarily lower costs – but they could possibly limit competition in the industry, or individuals’ choice of providers. Thus, these two entities suggested that the state reexamine these laws, which could have implications for the roughly 30 other states that have such laws in place.
On October 21, 2015, the Office of the Inspector General (OIG) of the US Department of Health and Human Services issued an advisory opinion regarding health systems that provide free transportation to patients. The inspector general’s opinion was that large healthcare systems can provide free transportation without it constituting a violation of Anti-Kickback Statute. Although this opinion was issued in respect to a specific request from an unspecified rural health system, the judge’s full opinion does provide some clarity as to how health systems could not incur penalties under these statutes as a result of providing free local transportation, which was tentatively proposed by the OIG last year.
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