Molina Healthcare has joined the long line of insurers suing the government for failure to honor its obligations under the Affordable Care Act’s “risk corridor” program. According to Molina’s 84-page complaint filed Jan. 23,...more
The White House is reviewing proposed regulations to ease restrictions on certain financial arrangements between hospitals and physicians and on certain transactions between providers and patients. The proposed regulations,...more
From its inception the 340B program has been the subject of disputes between drug manufacturers and their safety-net hospital customers. On August 12 HHS proposed an administrative process for resolving those...more
In one of the more unexpected developments in recent Congressional history, a House Ways & Means Committee vote relating to the Affordable Care Act (ACA) turned partisan. Astonishingly, all the Republicans voted one way; all...more
On February 11, 2016, the Centers for Medicare & Medicaid Services (CMS) released the much anticipated final rule on the so-called “60-day rule.” The long road to the final rule began when the Affordable Care Act (ACA)...more
A new 2016 Medicare physician payment rule allows hospitals and other provider institutions to make payments to physicians for the purpose of enabling them to employ nonphysician practitioners, such as nurse practitioners and...more
The Stark Law generally prohibits physicians from referring Medicare and Medicaid patients to facilities in which they have an ownership interest. There used to be a “whole hospital exception” excluding entire hospitals (as...more
When the Affordable Care Act (ACA) was signed into law back in 2010, it directed the Centers for Medicare & Medicaid Services (CMS) to establish the Consumer Operated & Oriented Program (CO-OP). The point of the CO-OP is to...more
Yesterday’s Washington Post “Business of Dying” article is a sobering account of how little information is available on the quality—or lack of quality—of hospice organizations. Almost no information on quality is available...more
Once again the Obama administration has been tripped up in launching a healthcare-related online system. This time the problem concerns the Physician Payments Sunshine Act—the act that is supposed to enable the public to see...more
Earlier this week HHS came out swinging in the latest round of its battle with the Pharmaceutical Research & Manufacturers of America (PhRMA) over the Affordable Care Act’s provisions on 340B and orphan drugs. HHS reasserted...more
It’s a question CMS has been wrestling with since the enactment of the Sunshine Act (sometimes called the Open Payments Program) as part of the Affordable Care Act. The Sunshine Act generally requires a manufacturer to...more
Last Friday a federal district court invalidated a regulation that had authorized the 340B discount for critical access hospitals, sole community hospitals, rural referral centers and free-standing cancer hospitals when they...more