In the wake of the implementation of the Affordable Care Act, the recent Medicare Managed Care Proposed Rule (the Proposed Rule) exemplifies the accelerated push by the Department of Health and Human Services and Centers for...more
This article is part of a series that takes an in-depth look at several proposals that would affect managed care organizations, health care providers and other industry stakeholders participating in, and contracting with...more
CMS seeks to impose more rigorous program integrity requirements for contractors and states.
This article is part of a series that takes an in-depth look at several proposals that would affect managed care organizations,...more
States would have the option to create binding Medicaid MLR requirements modeled after existing commercial market MLR standards.
This article is part of a series that takes an in-depth look at several proposals that...more
The proposals strive to balance increased federal government oversight and administration with continued recognition of, and flexibility for, state managed care programs.
This is the first article in a series that takes...more
The Centers for Medicare & Medicaid Services proposes significant changes to several key Medicare Part D Program components, such as the “any willing pharmacy” contracting requirement, that will affect all industry...more
The Centers for Medicare & Medicaid Services continues to take an expansive view of the overpayment refund requirement, which in turn can give rise to False Claims Act liability for Medicare Advantage Organizations and Part D...more
On February 15, 2013, the Centers for Medicare & Medicaid Services released for comment two key documents affecting the Medicare Advantage (MA) and Part D Programs: (1) the Advance Notice of Methodological Changes for...more
On January 1, 2013, the U.S. Congress approved the American Taxpayer Relief Act of 2012 (the Act), concluding a protracted debate on how to prevent the United States from falling over the proverbial “fiscal cliff.” President...more