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Delaware Health Law Blog

Delaware Health Insurers Required to Provide Free Coverage for Immunizations

As required by the federal Health Care Reform law (the Patient Protection and Affordable Care Act), the Delaware General Assembly passed amendments to the state’s insurance code requiring health insurance carriers providing coverage in Delaware to cover certain immunizations and preventive services without requiring enrollees to pay copayments, coinsurance or deductibles.

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Fraud Investigations Aiming for the Top: Government Scrutiny of Health Care Executives

In his testimony before a House of Representatives subcommittee, Chief Counsel for the HHS-OIG Lewis Morris expressed the Federal Government’s frustration with repeat offenders and indicated a new strategy for fighting fraud and abuse among health care enterprises.

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Health Care Practices Must Inform Employees of Labor Rights

On August 30, 2011, the National Labor Relations Board (NLRB) issued a final rule that will require all private employers, including health care practices, covered by the National Labor Relations Act (NLRA) to notify employees of their rights under the Act. This notification’s substance is included on a poster provided by the NLRB, which informs employees of their rights, among others, to join a union and collectively bargain.

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Feds Deny Delaware Insurance Commissioner’s Application for Medical Loss Ratio Adjustment

In a September 9th letter the Centers for Medicare & Medicaid Services denied Delaware Insurance Commissioner Stewart’s application for an adjustment to the 80 percent medical loss ratio (“MLR”) standard applicable to the individual health insurance market in Delaware beginning in 2011 as a result of the federal health care reform legislation, the Patient Protection and Affordable Care Act (the “Act”).

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Third Circuit Adopts Implied False Certification Liability under False Claims Act

“Men must turn square corners when they deal with the government.” While Justice Holmes penned the above quote in a different context, it was recently invoked by the United States Court of Appeals for the Third Circuit in its decision to adopt the implied false certification theory for liability under the False Claims Act (“FCA”). In United States ex rel Wilkins v. United Health Group, the Third Circuit joined the Second, Sixth, Ninth, Tenth, Eleventh, and District of Columbia Circuits in recognizing that healthcare providers can be liable under the FCA if the provider makes a claim for payment without disclosing that it violated regulations that affect its eligibility for payment.

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New Delaware Health Care Facility Inspection Law Goes Into Effect

Just six weeks after Governor Markell signed into law HB 47 authorizing the Division of Public Health to investigate and inspect unsanitary or unsafe conditions in certain facilities where invasive medical procedures are performed, the Division shut down a Dover dermatology practice after receiving 10 complaints from patients and former employees of the Center for Dermatology.

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Reverse False Claims-The Latest in False Claims Act Exposure

Earlier this week, the Department of Justice announced that it had its second largest annual recovery of civil fraud claims in history, securing $2.4 billion in settlements and judgments in cases involving fraud against the government in the fiscal year ending Sept. 30, 2009.

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Responding to Subpoenas

Recently there has been a surprising increase in the number of subpoenas served on health care providers. Fraud investigations, overpayment investigations, licensing board investigations, carrier audits, personal injury and workers compensation claims, all generate demands for production of records (and sometimes interviews). And while subpoenas have become commonplace for medical practices, the response to a subpoena cannot be treated lightly.

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Delaware Enacts New Laws Impacting Medical Professionals

In the wake of the investigation and prosecution of Dover pediatrician Earl Bradley on hundreds of counts of sexual assault and child molestation, the Delaware General Assembly passed a series of bills designed to enhance the effectiveness of regulators who license medical professionals and law enforcement officials charged with investigating and prosecuting crimes of abuse in Delaware, which bills were signed by Governor Markell on June 30, 2010.

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Delaware Court Upholds Restrictive Covenant in Physician Employment Agreement

In a recent Memorandum Opinion, Judge Herlihy of the Delaware Superior Court held that a restrictive covenant in a physician employment agreement that required the physician-employee to pay the medical practice employer $200,000 in liquidated damages if, during the 2-year period following termination of the agreement, the physician-employee practiced medicine or treated former patients of the employer within a 20-mile radius of the medical practice’s locations, is enforceable as a matter of law.

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