Bridgette Keller

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OIG Says Proposed MCO Incentive Program Protected by AKS Safe Harbor

In its favorable Advisory Opinion 18-11, the OIG explains how a managed care organization’s proposed incentive program to pay network providers to increase the amount of Early and Periodic Screening, Diagnostic, and Treatment...more

11/20/2018 / Advisory Opinions , Anti-Kickback Statute , Beneficiaries , Health Care Providers , Incentives , Managed Care Contracts , MCOs , Medicaid , OIG , Safe Harbors

The Managed Care Industry – 2015 Year in Review

As we start a new year, let’s take a look back at a few hot topics that emerged in the managed care industry in 2015 and will likely be drivers of developments in 2016. Industry Consolidation – The Changing Landscape...more

1/6/2016 / ACOs , Affordable Care Act , Healthcare , Hospital Mergers , Managed Care Contracts , MCOs , Medicare Part D , Provider Payments , Shared Savings Program

Over a Decade in the Making: CMS Releases Long-Awaited Medicaid Managed Care Rule

On May 27, 2015, the Centers for Medicare and Medicaid Services (“CMS”) published a 653-page proposed rule affecting the thirty-nine states (plus the District of Columbia) that use managed care organizations (“MCOs”) to...more

6/8/2015 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Managed Care Contracts , Medicaid

CMS Call Letter: Medicare Advantage Contracting Considerations

As a final addition to our series on the 2016 Draft Call Letter, we highlight some of the MA contracting issues raised by the Centers for Medicaid and Medicare Services (“CMS”). Specifically, CMS (1) recommends Medicare...more

3/9/2015 / Centers for Medicare & Medicaid Services (CMS) , Healthcare , Managed Care Contracts , Medicare , Medicare Advantage

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