Last week, the United States District Court for the District of Columbia denied CMS’s request to remand to the Provider Reimbursement Review Board (PRRB) the claims of several hospitals who sought expedited judicial review...more
Last week, the United States Court of Appeals for the District of Columbia Circuit reversed and remanded the Medicare appeals backlog case American Hospital Association v. Price to the district court. As previously reported,...more
On July 13, 2017, CMS proposed a rule (Proposed Rule) updating payment policies and rates, as well as the quality provisions, for the Medicare Physician Fee Schedule (PFS). Among other provisions, the Proposed Rule reduces...more
7/18/2017
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FQHC ,
Hospitals ,
Medical Malpractice ,
Medicare ,
Medicare Shared Savings Program ,
Off-Campus Departments ,
Physician Fee Schedule ,
Physicians ,
PQRS ,
Request For Information ,
Rural Health Care Providers ,
Telehealth
On April 28, 2017, the United States Court of Appeals for the District of Columbia Circuit rejected Anthem, Inc.’s (Anthem’s) appeal of the D.C. district court’s order blocking its proposed $54 billion acquisition of Cigna...more
On April 5, 2017, the Office of Management and Budget (OMB) issued a memorandum that outlines the proper procedures for agencies to comply with Executive Order (EO) 13771. EO 13771 was issued on January 30, 2017 with goals...more
Last week, the U.S. House of Representatives passed a bill that would end the limited Federal antitrust immunity for health insurers. The Competitive Health Insurance Reform Act of 2017 (H.R. 372) passed the House 416-7 and...more
On February 8, 2017, the United States District Court for the District of Columbia granted a request filed by the U.S. Department of Justice’s Antitrust Division for an injunction blocking Anthem, Inc.’s (Anthem) proposed $54...more
On January 23, 2017, the United States District Court for the District of Columbia granted the Department of Justice, Antitrust Division’s (DOJ) request for an injunction to block Aetna Inc.’s (Aetna) proposed acquisition of...more
In a unanimous opinion issued December 6, 2016, the U.S. Supreme Court held that violation of the False Claims Act’s (FCA’s) seal requirement is not grounds for automatic dismissal. The Court declined to provide guidance for...more
On November 21, 2016, the U.S. District Court for the District of Columbia heard opening arguments in the Department of Justice’s lawsuit challenging the proposed merger between Anthem, Inc. and Cigna Corporation. This is...more
On October 3, 2016, OIG released a report monitoring CMS’s progress on preparing for the implementation of the new payment system for clinical laboratory tests. The new payment system was mandated by the Protecting Access to...more
Oregon has requested $1.25 billion in federal funding to expand the Oregon Health Plan (OHP), a coordinated care model implemented under Section 1115(a) of the Social Security Act. The current OHP Section 1115 demonstration...more