Medicare Drug Price Negotiations

In 2022, the United States Congress passed the Inflation Reduction Act (IRA) which gave Medicare the authority to negotiate certain prescription drug prices with manufacturers for the first time. The intent of this law is to reduce the cost of some of the most expensive drugs and increase access to patients through Medicare Part B…Read More

LLC Operating Agreements

This is the third part of a several part series of articles pertaining to limited liability company operating agreements. This third installment addresses capital calls, covenants not to compete and fiduciary duties.  Many medical practices and other health care enterprises operate as limited liability companies (LLCs), and are, therefore, governed by the LLC’s “operating agreement.”…Read More

No Surprises Act– A New and Improved Proposed Rule

The No Surprises Act (NSA), effective January 1, 2022, generally protects patients from receiving unanticipated bills for emergency care rendered by providers who do not participate with the patient’s insurance coverage (out-of-network providers), and includes a prohibition on certain out-of-network providers balance billing patients. The law also requires that the patient’s insurer reimburse the out-of-network…Read More

New OIG Compliance Guidelines

In the first major update in fifteen years, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) recently released new voluntary compliance program guidelines (CPGs) for health care companies aimed at preventing fraud and waste in the health care system.  Last spring, the OIG announced plans to update and to…Read More

Doctors Unionizing

In March 2023, approximately 100 physicians at a Minneapolis hospital owned by Allina Health voted to unionize. Just seven months later, over 400 primary care physicians employed in clinics owned by the same health system also voted to join the Doctors Council of the Service Employees International Union.   This recent push to unionize is…Read More

Navigating Financial Risks in Healthcare: Strategies for Mitigation

Amidst the financial complexities and risks facing the healthcare sector, from inflation and outdated contracts to workforce shortages and diminishing market share, healthcare organizations are navigating a challenging landscape. Effective mitigation strategies include service line assessments, workforce prioritization, leveraging patient feedback, outsourcing non-clinical tasks, and seeking strategic collaborations. These measures are vital for enhancing financial…Read More

LLC Operating Agreements

This is the second part of a several part series of articles pertaining to limited liability company operating agreements. This second installment addresses voting rights, distributions, capital accounts, buy-ins and buy-outs. Many medical practices and other health care enterprises operate as limited liability companies (LLCs), and are, therefore, governed by the LLC’s “operating agreement.” However,…Read More

New Proposed Merger Guidelines

Recently, the U.S. Department of Justice (DOJ) and Federal Trade Commission (FTC) released Draft Merger Guidelines (Draft Guidelines) outlining various new factors the Agencies will consider when reviewing the legality of mergers and acquisitions.   The Draft Guidelines set forth 13 new frameworks that the Agencies will use to determine whether a merger violates antitrust…Read More

Proposed Rule on Ownership of Nursing Homes

On February 13, 2023, the Department of Health and Human Services (HHS) proposed a new rule that would require most nursing homes to provide detailed information about facility owners, operators, and management teams, including clinical consulting and administrative services. The Rationale The proposed rule would implement the reporting requirements initially created by Section 6101(a) of…Read More