By Susrut A. Carpenter, Carl W. Hittinger and George A. Stamboulidis
On April 30, 2019, the Criminal Division of the U.S. Department of Justice (“DOJ”) released a new corporate compliance guidance document for prosecutors titled “Evaluation of Corporate Compliance Programs” (“Guidance”). The Guidance sheds light on how the DOJ evaluates the effectiveness of a company’s compliance program – whether white collar- or antitrust-oriented – focusing on the program’s design, implementation and practical application. Notably, this Guidance applies to the entire Criminal Division as opposed to only the Fraud Section, to which the prior 2017 guidance applied. In fact, the head of the DOJ’s criminal division, Assistant Attorney General Brian Benczkowski, in a speech at the 2019 Ethics and Compliance Initiative Conference, explained that one of the purposes of the Guidance is to “better harmonize the prior Fraud Section publication with other Department guidance and legal standards.”
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On Feb. 11, 2019, two Department of Health and Human Services (HHS) agencies, the Office of the National Coordinator for Health Information Technology (ONC) and the Centers for Medicare and Medicaid Services (CMS), released their long-awaited proposed rules designed to further HHS’ goal of promoting electronic health information interoperability and implementing many of the provisions mandated under the 21st Century Cures Act (Cures Act). Notably, these proposed rules were released shortly before the HHS Office for Civil Rights deadline for comments about potential changes to improve coordinated care. Taken together, recent HHS rulemakings suggest that interoperability is coming, and significant requirements are in store for providers, payors, health information technology developers and players.
On March 6, 2019, the U.S. Department of Justice (DOJ) announced that Linda Sue Kalina pled guilty to wrongfully disclosing the protected health information (PHI) of another individual in violation of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Kalina was a patient information coordinator with the University of Pittsburgh Medical Center (UPMC) and its affiliate, Tri Rivers Musculoskeletal Centers (TRMC). From March 7, 2016, through June 23, 2017, Kalina improperly accessed the health information of 111 UPMC patients who had never been provided services at TRMC. In her capacity as a patient information coordinator, Kalina was authorized to access patient information contained in UPMC’s electronic medical record system as necessary to provide services to patients. Among others, Kalina accessed and disclosed the health information involving two individuals who worked at Kalina’s former employer. 
Recently, in Dantry v. Unemployment Compensation Board of Review, No. 1665 C.D. 2017 (Pa. Cmwlth. 2019), the Commonwealth Court of Pennsylvania reversed the order of the Unemployment Compensation Board of Review (Board) which had affirmed the Unemployment Compensation Referee’s decision that Jami M. Dantry (Dantry) was ineligible for unemployment compensation benefits because Dantry’ s conduct rose to the level of willful misconduct based on a violation of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the Family Educational Rights and Privacy Act (FERPA), and for insubordination. The Commonwealth Court of Pennsylvania remanded the matter to the Board for the issuance of a decision determining whether Dantry’s alleged insubordination constituted willful misconduct.
Senate Democrats recently introduced the Stop Price Gouging Act (S. 378), which seeks to place an excise tax on pharmaceutical companies in proportion to price spikes on prescription drugs.
Private equity (PE) investors entered the physician practice management (PPM) market in 2011, and eight years later the PPM sector continues to be a ripe middle market for PE investors looking to diversify their portfolios. However, as the healthcare market continues to change in light of increasing vertical integration between payors and providers and disruption caused by new players such as Amazon, changes may be on the horizon for PE investment in the PPM space. 
