On December 12, 2019, the U.S. House of Representatives passed a major Democratic drug-pricing bill, H.R. 3, or the “Elijah E. Cummings Lower Drug Costs Now Act.” If enacted, HHS would be allowed to negotiate the prices of...more
On November 4, 2019, Georgia officials announced a proposed Section 1115 demonstration waiver, referred to as the “Georgia Pathways Health Waiver,” to expand Georgia’s Medicaid program eligibility for non-disabled adults. If...more
On September 17, 2019, the U.S. Court of Appeals for the Third Circuit revived three whistleblowers’ claims alleging that the University of Pittsburgh Medical Center (UPMC) and neurosurgeons employed by three subsidiary...more
10/1/2019
/ Appeals ,
Dismissals ,
Employment Contract ,
False Claims Act (FCA) ,
Health Care Providers ,
Healthcare Fraud ,
Hospitals ,
Medicare ,
Remand ,
Reversal ,
Stark Law ,
Universities ,
Whistleblowers
On June 21, 2019, CMS finalized a decision memo updating the national coverage policy for Transcatheter Aortic Valve Replacement (TAVR), a procedure used to address aortic stenosis. The decision changes the volume...more
On April 26, 2019, CMS issued a letter to State Medicaid Directors (2019 Letter) inviting states to partner with CMS in one of three new opportunities to test state-driven approaches to integrating care for individuals who...more
On February 28, 2019, CMS issued a 48-page request for public comment (the Request) on several potential updates to and future considerations for the methodology used in the Overall Hospital Quality Star Rating. As explained...more
On January 22, 2019, twenty-two (22) Senators sent a bipartisan letter to HHS (the Letter) to voice their concerns over a change in the national liver distribution policy adopted on December 3, 2018 (Revised Policy), by the...more
On November 30, 2018, CMS launched the Procedure Price Lookup tool that enables consumers to search the tool by type of procedure to compare the national average cost for procedures performed in both ambulatory surgery...more
On July 31, 2018, the U.S. Court of Appeals for the Fifth Circuit weighed in on a five-year out-of-network payment dispute between Aetna Life Insurance Co. (Aetna) and North Cypress Medical Center (NCMC), a physician-owned...more
Days before the Medicaid work requirement for Medicaid patients in Kentucky was to take effect, U.S. District Court Judge James Boasberg struck down the requirement in a decision issued June 29, 2018....more
On May 30, 2018, the Community Oncology Alliance, Inc. (Alliance), a non-profit organization that advocates for community oncology practices, sued HHS, HHS Secretary Azar, the Office of Management and Budget (OMB) and OMB...more
On May 8, 2018, the Senate passed S. 1732, a bipartisan bill giving CMS the authority to offer incentive payments to “behavioral health providers” who implement certified electronic health records. The bill, titled,...more
A March 27, 2018 decision by the United States Court of Appeals for the Fifth Circuit, Family Rehabilitation Incorporated v. Azar, II, No. 17-11337 (“Family Rehab”), potentially paves the way for Medicare providers to seek...more
The U.S. Department of Justice elected not to file a second amended complaint-in-intervention in U.S. ex rel. Poehling v. UnitedHealth Group Inc., 2:16-cv-08697, a Federal False Claims Act (FCA) case pending in the U.S....more
On January 4, 2018, OIG issued a letter to Pharmaceutical Research and Manufacturers of America (PhRMA) addressing OIG’s Final Notice of Rescission of OIG Advisory Opinion No. 06-04 dated November 28, 2017. The OIG’s 2018...more
On October 13, 2017, HHS issued a transmittal change request to update Section 3.9 of the Medicare Program Integrity Manual (MPIM), stating that only one entity (CMS or a CMS contractor) may attend an ALJ hearing as a party,...more
On September 5, 2017, the Department of Justice (DOJ) announced that six Tennessee-based home health entities agreed to pay the United States $1.8 million to settle potential violations of the Stark Law and/or Anti-Kickback...more
CMS has issued guidance documents addressing how hospitals can (1) qualify an off-campus provider-based department (PBD) for the “mid-build” exception set forth in the 21st Century Cures Act and (2) request from their CMS...more
On November 30, 2016, the House of Representatives passed the 21st Century Cures Act, a bill intended to modernize health care delivery and speed up and improve medical research and innovations by removing bureaucratic...more
12/8/2016
/ 21st Century Cures Initiative ,
Centers for Medicare & Medicaid Services (CMS) ,
Food and Drug Administration (FDA) ,
Healthcare ,
Long Term Care Facilities ,
Medicaid ,
Medicare ,
MedPAC ,
National Institute of Health (NIH) ,
Pharmaceutical Industry ,
Sunshine Act ,
Telemedicine
The United States Court of Appeals for the Fifth Circuit, in a per curium decision issued October 27, 2016 in Forte v. Wal-Mart Stores, Inc., vacated approximately $1.4 million in statutory civil penalties awarded by the...more
On September 28, 2016, CMS issued a final rule to improve the care and safety of nursing home residents in long-term care facilities. The new rules are intended to reduce unnecessary hospital readmissions and infections,...more
On August 2, 2016, CMS released a final rule (Final Rule) with updates to the Hospital Inpatient Prospective Payment System (Hospital IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) affecting...more
8/10/2016
/ Administrative Procedure Act ,
Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Final Rules ,
Hospitals ,
IMPACT Act ,
Inpatient Prospective Payment System (IPPS) ,
Inpatient Quality Reporting ,
Long Term Care Facilities ,
Medicare ,
Provider Payments ,
Two-Midnight Rule ,
Value-Based Purchasing
On June 30, 2016, Senate Finance Committee Chairman Orrin Hatch released a white paper examining potential reforms to the Federal Stark law. The white paper, entitled “Why Stark, Why Now? Suggestions to Improve the Stark...more