Medicare Advantage (MA) plans now cover about half of Medicare beneficiaries, and with that enrollment growth has come increased scrutiny from federal and state regulators. As federal regulators complete a busy season of...more
3/28/2023
/ Audits ,
Centers for Medicare & Medicaid Services (CMS) ,
Continuing Legal Education ,
Enforcement ,
False Claims Act (FCA) ,
Health Care Providers ,
Health Insurance ,
Health Plan Sponsors ,
Medical Necessity ,
Medicare ,
Medicare Advantage ,
Medicare Advantage Organizations (MAOs) ,
Medicare Beneficiaries ,
New Rules ,
Risk Adjustment Formula ,
Webinars
A New Manatt Webinar Guides You Through New Reforms Promoting Value-Based Care and Easing Regulatory Compliance—the Most Significant Changes to the Federal Fraud and Abuse Landscape in the Last Decade.
On November 20,...more
12/22/2020
/ Anti-Kickback Statute ,
Continuing Legal Education ,
Cybersecurity ,
Department of Health and Human Services (HHS) ,
Digital Health ,
Electronic Medical Records ,
Final Rules ,
Fraud and Abuse ,
Health Care Providers ,
Healthcare Fraud ,
Healthcare Reform ,
Medicaid ,
Medicare ,
OIG ,
Physicians ,
Self-Referral ,
Stark Law ,
Value-Based Care ,
Webinars
Discover the Trends in Healthcare Transactions, the Drivers Behind the Changes and What Lies Ahead as Stakeholders Deal With the Pressures of the Pandemic...
After years of growth, healthcare deal activity slowed in the...more
12/1/2020
/ Acquisitions ,
Antitrust Provisions ,
Continuing Legal Education ,
Coronavirus/COVID-19 ,
Health Care Providers ,
Health Plan Sponsors ,
Healthcare Facilities ,
Hospitals ,
Industry Consolidation ,
Medicaid ,
Medicare ,
Mergers ,
Physicians ,
Restructuring ,
Webinars
Editor’s Note: People eligible for both Medicare and Medicaid experience co-occurring substance use disorders (SUDs) and chronic pain at rates that are two to six times higher than Medicare-only beneficiaries or Medicaid-only...more
On December 21, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a final rule redesigning the Medicare Shared Savings Program (the Program) for Accountable Care Organizations (ACOs). The policies reflected in...more
CMS Issues Self-Referral Disclosure Protocol for Stark Law Violations -
On March 28, 2017, the Centers for Medicare & Medicaid Services (CMS) issued a new voluntary self-referral disclosure protocol (SRDP) for disclosing...more
4/25/2017
/ Affordable Care Act ,
Anti-Steering Rules ,
Antitrust Provisions ,
Centers for Medicare & Medicaid Services (CMS) ,
Deceptive Intent ,
Department of Justice (DOJ) ,
Drug Pricing ,
Healthcare Reform ,
Medicaid ,
Medicare ,
Pharmacist ,
Self-Referral ,
Stark Law ,
Telehealth ,
Trump Administration
Balancing Gene Therapy’s Promise and Price -
Editor’s Note: Exciting advances in science have led to developing treatment breakthroughs, such as gene scripting therapies, that could represent the first potential cures...more
12/20/2016
/ Affordable Care Act ,
Anti-Kickback Statute ,
Civil Monetary Penalty ,
Final Rules ,
Healthcare Reform ,
Hospice ,
MCOs ,
Medicaid ,
Medicare ,
Non-Discrimination Rules ,
OCR ,
OIG ,
Safe Harbors ,
Telehealth
Since the passage of the Affordable Care Act (ACA), both federal and state policies have promoted the adoption of alternative payment models (APMs), providing financial incentives for groups of providers to improve care...more
5/23/2016
/ ACOs ,
Alternative Payment Models (APM) ,
Anti-Kickback Statute ,
Antitrust Violations ,
Children's Health Insurance Program (CHIP) ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
Federal Trade Commission (FTC) ,
Fraud and Abuse ,
Hospital Mergers ,
Hospitals ,
Medicare ,
Medicare Access and CHIP Reauthorization (MACRA) ,
Physicians ,
Sherman Act ,
Stark Law
Lessons from Hawaii's Trailblazing ACA 1332 Waiver Proposal -
Editor's Note: On September 9, Hawaii became the first state to post a draft 1332 waiver proposal for public comment. While Hawaii's proposal focuses on the...more
12/22/2015
/ Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Contraceptive Coverage Mandate ,
Department of Health and Human Services (HHS) ,
Freedom of Religion ,
Hospital Mergers ,
IRS ,
Long-Term Care ,
Medicare ,
Medicare Part B ,
OIG ,
Prescription Drugs ,
Public Health Insurance Marketplace ,
SCOTUS ,
Section 340B ,
Split of Authority ,
Stark Law ,
Waivers
In the fall of 2014, the Department of Health and Human Services Office of Inspector General released its 2015 Work Plan, which highlighted HHS’s compliance focus areas in the upcoming year.
As in past years, areas of...more
Avoiding the Regulatory Land Mines of Commercial ACOs -
While providers are showing great interest in creating ACOs to participate in the Medicare Shared Savings Program (MSSP), they are showing even greater enthusiasm...more
7/23/2014
/ ACOs ,
EHR ,
Halifax Hospital ,
Health Insurance ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Healthcare ,
Medicare ,
Medicare Shared Savings Program ,
Regulatory Standards ,
Reporting Requirements ,
Social Networks ,
Stark Law
Litigation Arising from the Affordable Care Act: The Blessing and Curse of Interesting Times -
The Affordable Care Act (ACA) has brought the most sweeping changes to the healthcare delivery and payment systems in the...more