New Horizontal Merger Guidelines and Health Care Reform

Apart from other impacts, the Patient Protection and Affordable Care Act (PPACA) will likely spur health care consolidation involving many hospitals, physicians and other industry stakeholders. Regardless of the form of combination pursued, antitrust compliance variables—including post-closing market …

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Can Employers Purchase Coverage in the State-Based Exchanges in 2014?

It depends on the size of the employer.  By January 1, 2014, each state must create a state-based health insurance Exchange that allows individuals and small businesses to purchase health insurance coverage.  A small business is generally defined as one with 100 or fewer employees, but states may choose to …

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Peer Review Privilege and Physician Employment: Balancing Competing Concerns

Medical staff peer review processes and hospital human resources practices are often addressed in separate spheres, even when a physician is both a medical staff member and an employee of the hospital. A federal district court recently held that the Colorado statutory privileges that protect the confidentiality of …

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OIG Issues Advisory Opinion Concerning Joint Ventures

The old French proverb “the more things change, the more they stay the same” comes to mind as one reads the HHS Office of the Inspector General’s most recent statements about joint ventures between heath care providers.  On September 8, 2010, the OIG issued an Advisory Opinion concerning a joint venture …

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IRS Guidance on Reimbursement of Over-the-Counter Drugs

Last Friday, the IRS issued Notice 2010-59, which provides guidance on Section 9003 of the Patient Protection and Affordable Care Act, which, effective January 1, 2011, limits the reimbursement of over-the-counter drugs under health FSAs, HRAs, HSAs, and Archer MSAs to only prescribed drugs or insulin. The Notice …

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Just Released: HHS Application Procedure for Annual Dollar Limit Waivers

In an earlier post, we discussed the interim final regulations issued relating to the prohibition of annual dollar limits on essential health benefits. Those regulations also provided that these restricted annual limits could be waived by the Secretary of HHS if compliance with the regulations would result in a …

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