Leslie Demaree Goldsmith

Leslie Demaree Goldsmith

Ober|Kaler

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"Next Generation" ACO Model Announced by CMS

In a March 10, 2015 press release, CMS announced a new addition to its existing Accountable Care Model (ACO) portfolio: Next Generation ACOs. As stated by CMS in its press release, this new ACO model will allow for already...more

4/9/2015 - ACOs Affordable Care Act CMS HHS Next Generation ACO (NGACO) Request for Application (RFA)

HHS to Continue Enforcing Orphan Drug Exclusion from 340B Program

The Department of Health and Human Services (HHS) through its Office of Health Resources and Services Administration (HRSA) announced last week that, although a court recently struck down its regulation addressing application...more

6/30/2014 - Covered Entities HHS HRSA Orphan Drugs Pharmaceutical PHRMA Prescription Drugs Section 340B

Medicare Bad Debt: Courts Again Uphold HHS's Stringent "Must Bill" Policy Requirements

On March 25, 2014, the United States District Court for the District of Maine upheld the decision of the Department of Health and Human Services (HHS) to withhold from Maine Medical Center (MMC), Medicare reimbursement for...more

5/5/2014 - Healthcare HHS Medicare

OIG Calls for Increased Scrutiny on Hospital Outlier Payments

In a recent report [PDF], the Department of Health and Human Services Office of the Inspector General (OIG) highlighted hospital outlier payment trends it found troubling: Of the nearly 3,200 hospitals reviewed, approximately...more

11/27/2013 - Healthcare HHS Hospitals IPPS Medicare OIG Outlier Payments

Expect Increased Medicare Denials for Incarcerated Beneficiaries and Unlawful Aliens

The Department of Health and Human Services’ Office of Inspector General (OIG) recently published two reports finding Medicare improperly paid providers millions of dollars for incarcerated beneficiaries and unlawful aliens...more

2/22/2013 - HHS Incarcerated Beneficiaries Medicare Medicare Claims Processing Manual OIG Unlawful Aliens

Court Again Rules Medicare’s “Must Bill” Policy for Medicare Dual Eligible Bad Debts Is Reasonable

The United States District Court for the District of Columbia once again upheld the decision of the Secretary of Health and Human Services (Secretary) to deny reimbursement for Medicare bad debts associated with copayments...more

12/5/2012 - HHS Medicaid Medicare

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