News

UT Medical Group Considering Bankruptcy in Wake of Verdict

UT Medical Group Inc. is considering bankruptcy after a Memphis jury found that delays in performing an urgently needed cesarean section resulted in a baby developing severe brain damage and cerebral palsy, and awarded a $33.5 million verdict against obstetrician Gary Lipscomb and UTMG. Through a statement delivered exclusively to the Memphis Business Journal, UTMG said the case remains subject to review by the appellate courts and settlement negotiations are ongoing. However, the verdict’s unusually high value has compelled the UTMG board to consider seeking protection through bankruptcy court.

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Clinic Seeks Dismissal of Meningitis Claims

In a move that could affect dozens of other cases, lawyers for the Nashville clinic where patients were injected with tainted steroids have filed a motion to dismiss suits filed on behalf of 14 Kentucky residents, The Tennessean reports. The motions, filed Monday in U.S. District Court in Boston, charge that the suits filed on behalf of the Kentucky residents do not meet the pre-notice requirements of Tennessee’s health care liability law. The motion also seeks to dismiss product liability and civil conspiracy charges under the same argument.

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Haslam: No Medicaid Expansion without Policy Waivers

Tennessee Gov. Bill Haslam has put a top Obama administration official on notice that if the state’s plan to expand Medicaid is not approved, an estimated 181,000 Tennesseans won't get coverage under the federal health care law, the Times Free Press reports. Haslam, who has been in negotiations with the government for months, wants to keep costs associated with any Medicaid expansion down by charging enrollees higher co-payments when they unnecessarily use expensive services or indulge in unhealthy habits. He also wants to reform provider reimbursements and modify services now required for "medically fragile" enrollees. Absent federal approval for those policy changes, Haslam warned he does not "see a path forward in the current environment that will allow us to extend coverage.”

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GOP Continues Court Attack on ACA

Two members of the Tennessee congressional delegation are taking part in a court challenge to President Barack Obama’s health care reforms. Reps. Marsha Blackburn, R-Brentwood, and Phil Roe, R-Johnson City, are part of a friend-of-the-court brief that contends the various taxes in the Affordable Care Act (ACA) are unconstitutional because they were added by the U.S. Senate. Under the Constitution, measures raising new revenues must originate in the House of Representatives. However, the district court that first considered the case dismissed their argument saying, “The Supreme Court has long held that … revenue bills are those that levy taxes, in the strict sense of the word, and are not bills for other purposes which may incidentally create revenue.” The Leaf Chronicle has more.

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Criminal Charges Considered in Meningitis Case

No criminal charges have been filed so far in the fungal meningitis outbreak that killed more than a dozen in Tennessee. But Michigan's attorney general and Boston's federal prosecutor say they’re now sharing evidence from their separate investigations, NPR reports. A federal grand jury in Boston has been investigating the New England Compounding Center for more than a year now, and the FBI recently made a plea through its website, asking anyone who received a tainted steroid shot to describe where and how they received the injection and what their illnesses have been. The pair spoke about the progress of the case at a press conference yesterday. “It’s a very complex, wide-ranging investigation," U.S. Attorney Carmen Oritz said. "I believe it’s moving very steadily forward. But no charges have been filed, as of yet.”

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Contraceptive Mandate Blocked in Federal Appeals Court

A federal appeals court based in Chicago has blocked the so-called contraceptive mandate that requires companies to provide contraceptive coverage in group health-care plans for employees, the ABA Journal reports. In a 2-1 decision, the 7th U.S. Circuit Court of Appeals ruled today on behalf of two closely held companies and their Catholic owners, who claimed the mandate under the Affordable Care Act violated their rights provided by the Religious Freedom Restoration Act.

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State Officials Warn of ACA Scams

Scam artists don't need special knowledge about the Affordable Care Act (ACA) to take advantage of unsuspecting victims, state officials say. The law's sheer complexity and the its rocky rollout have created ample opportunity for scam artists to target those worried about changes in their health coverage -- especially the elderly, says Kate Abernathy, spokeswoman for the Tennessee Department of Commerce and Insurance. So far, reports of scams include bogus websites, cold calls touting special ACA insurance cards and offers to help people sign up for insurance for a fee. The Chattanooga Times Free Press has more on the story.

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Haslam, Sebelius Differ on Status of Medicaid Talks

Gov. Bill Haslam said Wednesday he is continuing to have conversations with federal officials about a way to expand Medicaid coverage for Tennesseans, the Times Free Press reports. Haslam, who declined to pursue an expansion of Medicaid as part of the Affordable Care Act, is instead pursuing an expansion of TennCare. In a recent visit to the state though, U.S. Health and Human Services Secretary Kathleen Sebelius said her office has yet to receive specifics from Haslam. The governor denied that claim, saying his administration has "presented a specific plan.”

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Corker Joins in Co-sponsoring GOP Health Care Bill

Senator Bob Corker said today that he is joining in as a co-sponsor of a bill that he and 37 other Republican cosponsors say "would provide relief from Obamacare standards for current health care policies, giving Americans the freedom to keep their current health care plans if they so choose." The Chattanoogan has more.

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New TBJ Features Update on Med Mal

In the November issue, out today, the Tennessee Bar Journal looks at the Tennessee Medical Malpractice Act five years after two important statutes were enacted. Clinton L. Kelly writes about how the appellate courts have interpreted the notice statue and the certificate of good faith law. Also, don't miss words of wisdom from the students of the Law Launch Project, such as: "A group of people thrown into a pit of hell together will either kill each other or band together to fight the evil forces. I think in law school it happens both ways."

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Alexander: Bill Would 'Force' Administration to Provide Answers about Obamacare

Republican state Sen. Lamar Alexander told Fox News yesterday that he is going to introduce a bill next week to “force” the administration to provide answers about the Affordable Care Act rollout. The Chattanoogan reports that the proposal would require the administration to provide weekly reports to Congress andto  states on enrollment, efforts to resolve the site’s technological problems and information about the organizations that have contracted as navigators.

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Medicare Terms Still Make a Difference After 'Bagnall' Ruling

In her recent "Senior Moments" column, Knoxville lawyer Monica Franklin details the differences in the Medicare world between the terms "observation" and "admission." The use of one or other of the words can make a huge difference in whether your client will incur extra costs for the hospitalization and whether your client will receive the Medicare benefit to pay for skilled care in a rehabilitation facility. In the column, Franklin references Bagnall v. Sebelius, which at the Journal's press time was pending. Late last month, Judge Michael P. Shea ruled against the plaintiffs and granted the government's motion to dismiss the action.

The plaintiffs' main substantive claim was that observation status violates the Medicare statute because it deprives them of coverage they are entitled to by law. The judge dismissed this claim by relying on a federal appeals court case that held that it is permissible for Medicare to consider someone an inpatient only if she has been formally admitted by a hospital. Franklin notes that the Improving Access to Medicare Coverage Act of 2013 (H.R. 1179), currently in the Subcommittee on Health, provides that a three-day stay in the hospital, regardless of observation or admission status, would allow a Medicare beneficiary to receive benefits to pay for skilled care in a rehabilitation facility.

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St. Jude Names New Chief Legal Officer

Robyn Diaz has been named chief legal officer and senior vice president of St. Jude Children’s Research Hospital. With 10 years of health law experience and 15 years of experience in the health care industry, Diaz joined the hospital’s Office of General Counsel as associate general counsel in August 2010. She was promoted to deputy general counsel in May 2012. “Robyn’s expertise and experience provide a strong foundation upon which she will continue to excel as a member of our senior management team at St. Jude,” St. Jude Director and CEO Dr. William E. Evans said in a press release.

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Judge Grants Restraining Order on Controversial State Rules for Health Law Navigators

U.S. District Judge Todd Campbell issued a temporary restraining order today blocking Tennessee from enforcing part of the controversial emergency rules regulating the actions of people seeking to sign up the uninsured for coverage under the federal health law. The judge found issue with one of the definitions for a health law navigator and issued an injunction against it effective until Oct. 21, saying the rule was not “narrowed or tailored.” That language spelled out a navigator as anyone who “facilitates enrollment of individuals or employers in health plans or public insurance programs offered through the exchange.” The Tennessean has more.

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Deadline Set for Filing Meningitis Claims

A federal judge in Massachusetts has set Jan. 15, 2014, as the deadline for filing claims in the bankruptcy case against the New England Compounding Center. The order, signed by U.S. Bankruptcy Judge Henry Boroff, includes detailed instructions on the information victims or their survivors must provide to have their claims considered. Tennessee attorneys representing victims of the nationwide fungal meningitis outbreak said they were pleased that the order provides additional time to file a claim, The Tennessean reports. They note, however, that the deadline applies only to claims against the center. Claims filed against other entities such as hospitals and clinics are subject to a one-year limit in state law.

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Haslam: Navigator Rules Not Meant to be ‘Stumbling Block’

Following a Nashville judge’s decision yesterday to not block state rules concerning health insurance navigators and counselors, the parties now are preparing for next week’s preliminary injunction hearing. When asked about the case yesterday, Gov. Bill Haslam defended the rules saying they were approved by the legislature with wide bipartisan support and were enacted at the last minute only because of a delay in the federal guidelines. Saying he wants to see the exchanges work well, Haslam reiterated that that the rules are not “intended to be a stumbling block,” the Times Free Press reports. Meanwhile, opposition to the rules continues to grow. Yesterday, the city of Nashville filed an amicus brief supporting the suit challenging the state's position. The Tennessean has more.

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TRO Denied, Narrow Enforcement Urged in Navigator Rule

After an hour-long hearing on a request for what Chancellor Russell Perkins characterized as a total restraining order, the Davidson County chancellor this afternoon denied a request to enjoin all enforcement of the emergency rule restricting advice and facilitation of information to consumers and businesses under the Affordable Care Act. In its ruling, the court did admonish the state to narrowly enforce the act as only applying to federally defined “navigators.” The state appeared to agree with the request. A hearing on a preliminary injunction is set for Oct. 9.

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Federal Background Checks of Health Counselors on Hold

The Tennessee Department of Commerce and Insurance is backing off a requirement that health counselors be fingerprinted and undergo federal background checks before advising the public about health insurance options under the Affordable Care Act. The agency, which issued rules last week mandating federal background checks, now says there is not enough time to run checks through the federal system so basic background checks will have to do. It also clarified that anyone at a church or library can give advice without needing a background check so long as they are not handling confidential information. The Tennessee General Assembly previously passed legislation requiring background checks for those who handle sensitive information in the process of helping Tennesseans file for new health insurance coverage. Nashville Public Radio has the story.

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Vanderbilt Accused of ‘Patient Dumping’

Already facing lawsuits on its recent decision to lay off thousands of workers, Vanderbilt Medical Center is now being accused of discharging patients prematurely – a practice known as “patient dumping.” A suit working its way through circuit court in Nashville claims that the early discharge of a motorcycle accident victim is part of a broader practice the hospital uses when people are not able to pay for care they need. In response to the suit, lawyers for Vanderbilt deny that the care was deficient or that the patient was “dumped.” They have asked that the case be dismissed. In another story, The Tennessean reports that the hospital was fined $80,000 in 2008 for refusing to accept a patient with an “unstable emergency medical condition.”

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Are Lawyers Health Insurance Navigators?

The Tennessee Department of Commerce and Insurance has issued emergency rules requiring registration for individuals counseling or advising the uninsured on how to sign up for health care coverage or facilitate enrollment by companies under the Affordable Care Act. The rules implement legislation adopted earlier this year. The Tennessean reports that critics say the rules are overly broad, will delay their work, and will not protect the public from fraud. Due to the broad nature of the rules, the TBA is investigating how they might affect attorneys advising individual and business clients on health care insurance matters.

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Feds Boost Health Care Fraud Investigations, Including in Tenn.

Federal agencies are continuing to boost their efforts to investigate health care fraud, including in Tennessee, the Tennessean reports. Over the past four years, the Obama administration has recovered more than $14.9 billion in health care fraud judgments, settlements and administrative impositions, according to the U.S. Department of Health and Human Services. “If you trace back what our office has done in the last couple of years, you’d see a significant increase” in these types of fraud cases, said David Rivera, the acting U.S. attorney for the Middle District of Tennessee. Tennessee health care institutions such as Vanderbilt University, LifePoint Hospitals and HCA Holding have all recently faced fraud investigations.

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House OKs Rep. Black’s Health Care Bill

In another effort to undo part of the 2010 health care reform law, the House of Representatives passed a bill sponsored by Rep. Diane Black that would bar federal subsidies for people participating in newly created health insurance exchanges until the Obama administration sets up a system to verify if they are eligible. According to the Tennessean, the vote marked the 41st time the GOP-controlled House has tried since 2011 to repeal or delay the Affordable Care Act, also known as Obamacare. The Democratically controlled Senate is not expected to take up Black’s bill, and the president has threatened to veto it if it would pass.

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Magazine Predicts 12 ‘Hottest’ Practice Areas

The September issue of The National Jurist predicts the 12 "hottest" practice areas for the next decade. Those deemed to be “super hot” were health care, administrative, intellectual property and family law. Food and drug law, tax litigation, privacy law and compliance law were ranked as “hot.” And employment, energy, manufacturing and immigration law were judged “somewhat hot.”

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Judge Sets Deadline in Life Care Centers Lawsuit

Federal prosecutors won't know until next spring if a massive whistle-blower Medicare fraud lawsuit against Life Care Centers of America can proceed to trial. The case was filed in 2008 and merged with a similar 2012 lawsuit, which involves allegations that the company provided unnecessary, often harmful, therapies to patients in its assisted living facilities to maximize Medicare billings. The Chattanooga Times Free Press has more about the case and the Cleveland, Tenn., based company.

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Haslam in D.C. Seeking Medicaid Flexibility

Tennessee Gov. Bill Haslam was in Washington today to talk with federal officials about his “third way” Medicaid expansion. Though he doesn’t expect to come back with a definitive answer or proposal for the state legislature, the Memphis Business Journal reports that Haslam is weighing how his final decision will impact the state’s hospitals. When asked in a news briefing whether recent layoffs at Vanderbilt University Medical Center are relevant to the debate, Haslam said, “It’s something we have to take into account.” But he was quick to point out that the hospital’s financial troubles may be due more to sequestration, Medicare cuts and a reduction in federal disproportionate share payments.

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