Eric Klein

Eric Klein

Sheppard Mullin Richter & Hampton LLP

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New Study Finds Medicare Advantage Plans Pay Lower Prices Than Traditional Medicare

A new study by Stanford University researchers finds that Medicare Advantage plans pay lower prices than traditional fee-for-service (FFS) Medicare for most types of hospital admissions. According to the study—published...more

8/18/2016 - CMS Fee-for-Service Health Insurance HMOs Medicare Medicare Advantage PPOs Pricing Stanford University University Studies

Maryland Co-Op Claims Risk Adjustment Formula Discriminates Against Smaller Insurers

Maryland’s Evergreen Health Cooperative has filed for an injunction against the federal government to halt payment by the Consumer Operated and Oriented Plan (co-op) of the $22 million it owes to CareFirst BlueCross...more

6/24/2016 - Affordable Care Act Blue Cross CMS Health Insurance Risk Adjustment Formula

RECAP: Highlights from the Sixty-Ninth World Health Assembly in Geneva, May 23rd to 28th

Every year in May, the health ministers from all 194 World Health Organization (WHO) Member States meet at the WHO headquarters in Geneva to attend the World Health Assembly (WHA). As the decision-making body of WHO, the WHA...more

6/10/2016 - Conflicts of Interest Ebola Emergency Response Health Insurance Member State Undue Influence Claims World Health Organization

Day Three Notes – JP Morgan Healthcare Conference, San Francisco

On January 13, 2016, conference sessions surfaced interesting questions and approaches regarding the post-acute sector, bundled payment, emergency medicine and anesthesia. Post-Acute Focus: With more and more focus on...more

1/16/2016 - Ambulatory Surgery Centers Bundled Payments Hospitals JPMorgan Chase Physicians Professional Conferences

Day Two Notes – JP Morgan Healthcare Conference, San Francisco

It was another interesting day at JP Morgan, the healthcare conference that never disappoints. Surprising declarations of war and peace, partnering that really works and strong growth stories all were heard today....more

1/14/2016 - Anthem Blue Cross Bundled Providers CIGNA Healthcare Facilities Hospitals Joint Venture Medical Benefits Prescription Drug Coverage

Day One Notes – JP Morgan Healthcare Conference, San Francisco

Someone asked me last week what it was like to attend the JP Morgan Healthcare Conference in San Francisco, which started its annual run on January 11, 2016. Outside the conference hotel right now is the obligatory lunchtime...more

1/12/2016 - Health Information Technologies Hospital Mergers JPMorgan Chase Life Sciences Medicaid Professional Conferences

Federal Spotlight Continues to Shine on Physician-Owned Distributorships

A recent Senate Finance Committee hearing investigated the effects of physician-owned distributorships (“PODs”) on costs of care and patient safety, suggesting that the momentum for greater oversight of such business...more

1/5/2016 - Anti-Kickback Statute Congressional Investigations & Hearings Fraud Alerts Medical Devices OIG Physician-Owned Distributors Senate Finance Committee

The Next Rx: New Medicare Part D Initiative Advances Role of Medication Management in Reform

Medicare Part D’s Medication Therapy Management (MTM) program intends to optimize clinical benefits and avoid drug-related problems among eligible beneficiaries. MTM services—involving pharmaceutical and clinical...more

10/13/2015 - Medicare Medicare Part D Pharmacies Prescription Drug Coverage Prescription Drugs

The Supreme Court Holds That Medicaid Providers Cannot Sue To Enforce Federal Reimbursement Rate Standards

On March 31, 2015, the U.S. Supreme Court issued its decision in Armstrong v. Exceptional Child Center, Inc., holding that Medicaid providers cannot sue to enforce reimbursement standards set forth in federal Medicaid law....more

4/17/2015 - Armstrong v Exceptional Child Center Healthcare Medicaid Medicaid Act Physician Medicare Reimbursements Private Right of Action Reimbursements SCOTUS Supremacy Clause

Full Speed Ahead for Meaningful Use

On Friday, March 20, 2015, the Centers for Medicare and Medicaid Services (“CMS”) issued a proposed rule which would make significant changes to the federal Medicare and Medicaid Electronic Health Records (“EHR”) Incentive...more

3/26/2015 - CMS EHR Health Care Providers Healthcare Proposed Regulation

Time is Running Out to Avoid the Negative Effects of 2016 Value-Based Physician Payment Modifiers: CMS Releases Results of...

CMS recently released results of Medicare’s value-based payment modifier for 2015. This is the first year in which physicians are subject to adjustments under the payment system and, in this first phase of implementation,...more

3/16/2015 - CMS Medicare Physician Payments Physicians PQRS

HHS Launches New Payment and Delivery Model to Improve Oncology Care

Cancer care is notoriously complex, intensive and costly. With more than 1.6 million people diagnosed with cancer each year, there is a strong impetus towards reforming service delivery. Accordingly, the U.S. Department of...more

2/26/2015 - Cancer Healthcare HHS Medicare

New Venture Seeks to Support Independent Physicians in Texas

The Texas Medical Association (TMA) and Blue Cross Blue Shield of Texas are launching a new services company, TMA PracticeEdge, to facilitate bringing the benefits of value-based reimbursements to the state’s independent...more

2/11/2015 - Blue Cross Blue Shield Healthcare Physician Payments Physicians

Effects of the New Federal Spending Package on the Health Sector

In mid-December, President Obama signed into law a $1.1 trillion spending bill known as the “Consolidated and Further Continuing Appropriations Act, 2015” or “Cromnibus.”[1] This post explores provisions that relate to the...more

12/31/2014 - Affordable Care Act Appropriations Bill Cybersecurity Health Insurance Healthcare Medicare Popular

The National Association of Insurance Commissioners Weigh in on Issues of Network Adequacy

Network adequacy—a health plan’s ability to provide timely access to a sufficient number in-network providers—has become a matter of increased scrutiny during these early years of ACA implementation; Many consumer and...more

12/5/2014 - Affordable Care Act Health Care Providers Health Insurance NAIC

CMS Grants First Waiver of Stark Law Expansion Restrictions—Are More Ahead?

Are changes to the landscape of physician hospital ownership ahead? The Affordable Care Act amended the federal Stark Law to eliminate the “whole hospital exception” that permitted self-referrals provided the referring...more

12/4/2014 - CMS Healthcare Hospitals Physician Hospital Organizations Physician Ownership Self-Referral Stark Law Waivers

Exploring the Relationship Between Price and Competition Among Physician Practices

The latest from the Journal of the American Medical Association (JAMA) is a thematic issue organized around a prominent topic in healthcare: price, cost, and competition. Contributing to the debate is an article titled,...more

10/30/2014 - Competition Healthcare Healthcare Costs JAMA Physicians

From Competitors to Co-Adventurers, Seven Hospital Systems Join with Anthem Blue Cross to Shake Things Up in Southern California

Anthem Blue Cross and seven competing hospital systems in Southern California are joining forces to establish a new health plan offering, Vivity.[1] Operating with a combined 14 hospitals and approximately 6,000 physicians,...more

10/14/2014 - Blue Cross CalPERS Health Insurance Healthcare Hospitals

The True Meaning of “Save Money. Live Better” – Walmart Enters the Primary Care Market

As reported in the New York Times, Walmart has taken the plunge into the retail primary care healthcare delivery market. Walmart has opened six primary care locations in South Carolina and Texas and plans to open another six...more

9/9/2014 - Healthcare Wal-Mart

Pennsylvania gets a green light to pursue Medicaid expansion under an alternative model

The Centers for Medicare and Medicaid Services (CMS) has approved Pennsylvania’s demonstration proposal to expand Medicaid to adults with incomes through 133 percent of the federal poverty line. The state is the 28th...more

9/8/2014 - CMS Healthcare Medicaid Expansion

Shifting to Value-Based Reimbursement

The Blue Cross Blue Shield Association released an interesting survey over the summer (July 2014) that provides further evidence of the change that is now happening in the American healthcare delivery system....more

9/5/2014 - Blue Cross Blue Shield Healthcare Surveys Value-Based Purchasing

Nonprofit Hospital Revenue Growth Slows

For the second straight year in a row, nonprofit hospital expenses have increased more than revenue, according to a study of 383 hospital systems by Moody’s Investors Service released on August 27, 2014. In an article...more

9/4/2014 - Hospitals Non-Profits

Another Pioneer Leaves The West

Another withdrawal from the Medicare Pioneer Accountable Care Organization (ACO) program has occurred. Sharp Healthcare ACO, an affiliate of the Sharp integrated delivery system in San Diego, California, notified the Center...more

9/3/2014 - ACOs CMS Healthcare Medicare Shared Savings Program

Bundled Payments under the Affordable Care Act Continue to Gain Influence

The Center for Medicare and Medicaid Services (CMS) recently announced that it will add roughly 4,100 providers to the 2,400 existing providers testing the possible use of Medicare bundled payment contracts. Providers must...more

8/12/2014 - Affordable Care Act Bundling Rules CMS Employee Benefits Healthcare

Highlights from the Senate Special Committee on Aging’s Hearing on Medicare Observation Status

A recent Senate Special Committee on Aging hearing focused on the impact of Medicare observation status, a hospital outpatient designation for which Medicare covers fewer services and generally reimburses for services at a...more

8/7/2014 - Congressional Investigations & Hearings Hospitals Legislative Committees Medicare Two-Midnight Rule

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