Bridgette Keller on Medicare

Mintz IRA Update — Second Edition: Q1 2024

Mintz’s PBMs & Pharmacies practice is pleased to present the second edition of our Mintz IRA Update, a regular publication that delves into developments under the Inflation Reduction Act of 2022 (“IRA”) impacting the health...more

3/14/2024 / Drug Pricing , Healthcare , Inflation Reduction Act (IRA) , Medicare , Prescription Drugs

Senate Democrats Pass Long-Awaited Drug Pricing Reforms in Budget Reconciliation Bill

On August 7, 2022, after extensive deliberation, Senate Democrats passed their long-awaited reconciliation bill, the Inflation Reduction Act of 2022 (the Reconciliation Bill). In addition to climate and tax provisions, the...more

8/10/2022 / Anti-Kickback Statute , Biosimilars , Budget Reconciliation , Drug Pricing , Medicare , Medicare Part D , Out-of-Pocket Expenses , Pharmacy Benefit Manager (PBM) , Price Inflation , Transparency

Final Medicare Advantage and Part D Rule will Likely Require Medicare Advantage Plans to Update 2023 Bids under Maximum...

The Centers for Medicare & Medicaid Services (CMS) released its Final Rule on Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (Final Rule) late last...more

5/5/2022 / Anti-Kickback Statute , Centers for Medicare & Medicaid Services (CMS) , Final Rules , Medicaid , Medicare , Medicare Advantage , Medicare Part D , Out-of-Pocket Expenses , Proposed Rules

CMS Proposes Changes to Medicare Advantage Regulations: Network Adequacy, Beneficiary Access, MLR Reporting, and MOOP

Continuing our series analyzing the recently proposed Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs rules (Proposed Rule), this post focuses on a few...more

1/20/2022 / Centers for Medicare & Medicaid Services (CMS) , Medical Loss Ratio , Medicare , Medicare Advantage , Medicare Advantage Organizations (MAOs) , Medicare Part D , Out-of-Pocket Expenses , Proposed Rules , Public Health Emergency

GAO Studies Use of PBMs in Medicare Part D

GAO recently released a report analyzing the use of pharmacy benefit managers (“PBMs”) and efforts to manage drug spending and use in the Medicare Part D program. Importantly, the report found that use of PBMs reduced Part D...more

8/27/2019 / Centers for Medicare & Medicaid Services (CMS) , Drug Pricing , GAO , Medicare , Medicare Part D , Pharmaceutical Industry , Pharmacy Benefit Manager (PBM) , Prescription Drugs , Proposed Rules

The 2014 Overpayment Rule is Vacated: How We Got Here and Key Takeaways

Medicare Advantage Organizations (MAOs) have been hailing a federal judge’s recent ruling to vacate the 2014 Overpayment Rule. But, how did we get here? And what does it really mean for MAOs? ...The Medicare Advantage...more

9/27/2018 / Centers for Medicare & Medicaid Services (CMS) , False Claims Act (FCA) , Medicare , Medicare Advantage Organizations (MAOs) , Medicare Beneficiaries , Medicare Part B , Medicare Part C , Overpayment , Rulemaking Process

CMS Focuses on a Modern Medicare

Earlier this month, CMS proposed changes to the Medicare Physician Fee Schedule and Quality Payment Program with the goal of “modernizing Medicare and restoring the doctor-patient relationship.” The proposed changes achieve...more

7/23/2018 / Alternative Payment Models (APM) , Centers for Medicare & Medicaid Services (CMS) , Comment Period , Health Care Providers , Medicaid , Medicare , Medicare Part B , MIPS , Physician Fee Schedule , Physicians , Proposed Regulation

HHS Announces a “Settlement Express” Option for Medicare Appeals

HHS’s Office of Medicare Hearings and Appeals (OMHA) has long faced a backlog in Medicare appeals to Administrative Law Judges (ALJs). In an effort to address this backlog, OMHA established a Settlement Conference...more

5/31/2018 / Administrative Backlogs , Administrative Law Judge (ALJ) , Appeals , Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Dispute Resolution , Healthcare , Medicare , OMHA , Settlement Agreements , Settlement Conferences

CMS’s Advance Notice and Call Letter: How Medicare Plans Can Report, Identify, and Address the Opioid Epidemic

CMS has slowly but surely been providing additional guidance to Medicare Plans (Medicare Advantage and Part D plans) regarding steps they can and should take to address the opioid epidemic as it relates to their...more

3/5/2018 / Advance Notice , Call Letter , Centers for Medicare & Medicaid Services (CMS) , Healthcare , Medicare , Medicare Advantage , Medicare Part D , New Guidance , Opioid , Pharmaceutical Industry , Pharmacies , Prescription Drugs

Mintz Levin Health Care Qui Tam Update - Recently Unsealed Whistleblower Cases: March 2017

Trends & Analysis - ..This issue looks at 18 health care–related qui tam cases that were unsealed in whole or in part in late October through November 2016. ..The cases identified were filed in federal district courts...more

3/20/2017 / Anti-Kickback Statute , False Claims Act (FCA) , Medicaid , Medicare , Personal Care Assistants , Qui Tam , Traumatic Brain Injuries

Mintz Levin Health Care Qui Tam Update: Recently Unsealed Whistleblower Cases

Featured Unsealed Cases United States ex rel. Thomas v. Best Choice Home Health Care Agency, Inc., No. 2:13-cv-02209 (D. Kan.) - Complaint Filed: May 6, 2013 - Complaint Unsealed: October 24, 2016...more

New Rules for ACOs in the MSSP

CMS issued a final rule, published in the Federal Register on Friday, June 10, 2016, updating how the performance of ACOs participating in the Medicare Shared Savings Program (MSSP) is measured and compensated. This rule is...more

6/16/2016 / ACOs , Benchmarking , Centers for Medicare & Medicaid Services (CMS) , Final Rules , Medicare , Medicare Shared Savings Program

Government Announces Health Care Fraud “Takedown”

Earlier today, Attorney General Loretta Lynch announced the largest coordinated crackdown in the Medicare Fraud Strike Force’s eight-year history. The government brought charges against 243 individuals for approximately $712...more

6/19/2015 / Anti-Kickback Statute , Health Care Providers , Healthcare Fraud , Home Health Care , Home Healthcare Workers , Medicare , Medicare Fraud Strike Force , Medicare Part D , Nurses , Physicians

3 Key Take Aways from AHLA’s Institute on Medicare and Medicaid Payment Issues

Last week I attended the American Health Lawyers Association Institute on Medicare and Medicaid Payment Issues in Baltimore, Maryland. Taking a comprehensive approach to reimbursement issues, the program offered a variety of...more

4/3/2015 / Data Collection , Healthcare , Healthcare Fraud , Medicaid , Medicare , Professional Conferences

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

CMS Finalizes Policy Rules For Medicare Parts C and D

Earlier this month, the Centers for Medicare & Medicaid Services (CMS) released its final rules on policy and technical changes to the Medicare Advantage (MA) and Prescription Drug Benefit programs (Part D) for contract year...more

2/17/2015 / Centers for Medicare & Medicaid Services (CMS) , Final Rules , Healthcare , Medicare , Medicare Advantage , Medicare Part C , Medicare Part D

Do You Offer or Accept Copayment Coupons? OIG says YOU are Responsible for Compliance with Federal Law

In recent years, copayment coupon programs have become standard promotional practices for both large and small pharmaceutical manufacturers. Copayment coupons are typically offered to commercially insured patients in order...more

10/24/2014 / Co-payments , Coupons , Health Insurance , Healthcare , Medicare , Medicare Part D , OIG , Pharmaceutical Industry , Pharmacies , Physicians , Prescription Drugs

CMS Proposes Major Changes to Medicare Parts C and D

On January 10, the Centers for Medicare & Medicaid Services (CMS) published proposed rules labeled as “policy and technical” changes to the Medicare Advantage (Part C) and Medicare Prescription Drug Benefit (Part D) Programs....more

1/22/2014 / Centers for Medicare & Medicaid Services (CMS) , Medicare , Medicare Part C , Medicare Part D

Bridgette Keller

Mintz

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