Summer Swallow

Summer Swallow


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King v. Burwell: “Thy name is an opinion on the Affordable Care Act”

The U.S. Supreme Court in King v. Burwell, upheld the availability of subsidies to individuals who purchase health insurance on either a state or federal Exchange. While the Court’s 6-3 decision is being hailed politically as...more

6/29/2015 - Affordable Care Act Health Insurance Health Insurance Exchanges King v Burwell Public Health Insurance Marketplace SCOTUS State Health Insurance Exchanges Subsidies Tax Credits

Medicaid Managed Care Proposed Rules: The Intersection of Private Insurance and Government Programs

Approximately a quarter of all Medicaid expenditures is spent on the more than half of all beneficiaries (approximately 39 million by 2011 figures cited in the 2014 MACPAC Report) currently accessing part or all of their...more

6/9/2015 - CHIP CMS Health Insurance MACPAC Managed Care Contracts MCOs Medicaid Proposed Regulation Qualified Health Plans Rulemaking Process

Children’s Hospitals Obtain Temporary Injunction Against CMS

Challenging actions by the Centers for Medicare & Medicaid Services (CMS) under the Administrative Procedures Act (APA), Texas Children’s Hospital and Seattle Children’s Hospital obtained a preliminary injunction that enjoins...more

1/16/2015 - Administrative Procedure Act Auditors Children's Hospital CMS DSH Hospitals Medicaid Preliminary Injunctions Reimbursements

Medicaid ACOs: States’ Answer to Escalating Costs?

States increasingly are experimenting with the use of Accountable Care Organizations (ACOs) in their Medicaid programs as a possible avenue to curb the escalating costs of providing care to expanding Medicaid populations....more

10/3/2014 - ACOs Health Care Providers Healthcare Medicaid Medicare

The Sliding Scale of Health Coverage: Finding the Intersection of Cost, Access and Quality

While not a new concept, the use of narrow networks has become a lightning rod for the controversy surrounding qualified health plans (QHPs) offered on the insurance exchanges created under the Affordable Care Act (ACA) and...more

8/11/2014 - Affordable Care Act Healthcare Healthcare Reform NAIC Physicians Qualified Health Plans

Is It a Violation to Help?

In a May 21, 2014, letter to the President of the American Hospital Association (AHA), U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius confirmed HHS’s position that private, not-for-profit...more

5/30/2014 - American Hospital Association Charitable Donations CMS Health Health Insurance Exchanges HHS Hospitals Non-Profits Premiums Private Foundations Qualified Health Plans

Marketing to Medicaid Beneficiaries: Texas Proposed Rule Highlights Pitfalls for Providers

Earlier this month, the Texas Health and Human Services Commission (Commission) released a proposed rule, 1 TAC § 354.1452 that prohibits certain marketing activity by Medicaid and CHIP providers. The proposed rule has been...more

2/25/2014 - Beneficiaries CHIP Employee Benefits Healthcare HHS Medicaid

HHS's Mixed Messages: Identifying a Federal Healthcare Program When You See It

Recent seemingly contrary determinations by the U.S. Department of Health and Human Services (HHS) have fueled industry speculation regarding whether qualified health plans (QHPs) available on the health insurance exchanges...more

11/15/2013 - Affordable Care Act Anti-Kickback Statute Fraud Health Insurance Exchanges Healthcare HHS Qualified Health Plans

CMS Issues Final Rule Outlining Medicaid DSH Payment Reductions

CMS recently released the final rule confirming its methodology for carrying out reductions to Medicaid disproportionate share hospital (DSH) payments for fiscal year (FY) 2014 and FY 2015. DSH payments, which go to hospitals...more

9/27/2013 - CMS DSH Final Rules Healthcare Medicaid

Paying for Family Vacations With NIH Funds Triggers FCA Lawsuit and Settlement

Northwestern University will pay $2.93 million to settle a federal False Claims Act (FCA) lawsuit brought by a former employee who alleged Northwestern allowed a researcher to submit false claims under certain cancer research...more

8/13/2013 - False Claims Act (FCA) Fraud NIH Research Funding Travel Whistleblowers

Exclusions: OIG Offers Relationship Counseling to Providers

On May 8, 2013, the U.S. Department of Health and Human Services Office of Inspector General (OIG) issued an updated Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs...more

5/22/2013 - Civil Monetary Penalty Healthcare HHS Medicaid Medicare OIG Provider Payments

OIG Updates Provider Self-Disclosure Protocol

On April 17, 2013, the U.S. Department of Health and Human Services Office of Inspector General (OIG) published a revised Provider Self-Disclosure Protocol (SDP) that clarifies the process for healthcare providers, suppliers...more

4/19/2013 - Anti-Kickback Statute OIG Self-Disclosure Requirements


A new bill filed by Rep. Jeff Leach, R-Plano, if passed, would allow Texas courts the authority to prescribe service of citation through a social media site, such as Twitter or Facebook, in the absence of other more...more

3/15/2013 - Service of Process Social Media

CMS Provides Guidance For Amending Patient Medical Records

CMS recently released a transmittal providing instructions to contractors on acceptable methods for providers to amend, correct and incorporate delayed entries into a patient medical record. ...more

1/23/2013 - CMS Corrections Medical Records

Health Law Update — January 10, 2013

In This Issue: - Healthcare Provisions in the American Taxpayer Relief Act - the Good, the Bad and the Ugly - American Taxpayer Relief Act Amends Overpayment Recovery Time Limits - OIG Advisory Opinion Sheds...more

1/14/2013 - American Taxpayer Relief Act CMS Data Breach Electronic Medical Records Fraud Healthcare OCR OIG Overpayment Recovery Time Limits Pay-for-Performance Reporting Requirements Settlement

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