Tara Swenson

Tara Swenson

Mintz Levin

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Part D Woes, According to the OIG

On June 23, 2015, the OIG issued two reports focusing on fraud, waste, and abuse in the Part D program, the first “Ensuring the Integrity of Medicare Part D” and the second “Questionable Billing Practices and Geographic...more

7/2/2015 - CMS Fraud Alerts Healthcare Medicare Medicare Part D OIG Prescription Drug Coverage Prescription Drugs

CMS Changes Medicare Prescriber Enrollment Requirements

On May 6, 2015, CMS issued interim final rules relating to Medicare Part D beneficiary access to Part D drugs. Through the rules, CMS announced updates regarding the impending prescriber enroll or opt-out effective date,...more

5/15/2015 - CMS Health Care Providers Healthcare Medicare Medicare Part D Prescription Drugs Proposed Regulation

MA Risk Adjustment in the 2016 Call Letter and … in Health Care Fraud Charges

In past Call Letters, CMS has proposed and finalized significant changes to the Medicare Advantage risk adjustment system including, recalibrations, deletions and additions of diagnoses codes, and questioning of the value of...more

3/6/2015 - CMS Coding Healthcare Healthcare Fraud Medicare Medicare Advantage

CMS Releases 2016 Draft Call Letter

Last week, the Centers for Medicare & Medicaid (CMS) released its 2016 Advance Rate Notice and draft Call Letter (2016 Call Letter) for the Medicare Advantage (MA) and Medicare Part D programs. The 2016 Call Letter outlines...more

2/27/2015 - CMS Medicare Medicare Advantage Medicare Part D Pharmaceutical Pharmacies Physician Medicare Reimbursements

Supplemental Excepted Benefits? “It depends.”

Last week, HHS, along with the Department of Labor and the Treasury, provided long overdue guidance regarding the third category of supplemental “excepted benefits” as defined by Section 2791 of the Public Health Services...more

2/20/2015 - Affordable Care Act DOL ERISA Health Insurance HHS IRS Medicare Public Health Service Act Supplemental Benefits TRICARE

CMS Issues Rewards and Incentive Guidance to MA Plans

On December 4, 2014, CMS issued additional guidance regarding rewards and incentives programs (“RI Programs”). This guidance elaborates on whether an RI Program can target members with specific diseases, whether rewards can...more

12/19/2014 - CMS Healthcare Incentives New Guidance

The Contraception Coverage Controversy Continues…

As we have been discussing, the Affordable Care Act (“ACA”) requires all health plans to cover preventive health services for women, including all Food and Drug Administration (“FDA”)-approved contraceptives, at no cost (i.e....more

10/31/2014 - Affordable Care Act Burwell v Hobby Lobby Contraceptive Coverage Mandate Contraceptives DOL Employer Mandates FDA First Amendment HHS Religious Exemption Religious Freedom Restoration Act SCOTUS

Front End Changes and, Again, More DIR Columns

Since the beginning of the Medicare Part D program, CMS has introduced many reporting mechanisms for trying to understand drug pricing, price concessions, and the cost of providing services to Part D members. The tool CMS...more

10/20/2014 - CMS Health Plan Sponsors Healthcare Hospitals Medicare Part D Pharmaceutical Manufacturers Pharmacies Prescription Drug Coverage Prescription Drugs Reporting Requirements

CMS Continues to Struggle with How to Provide High Quality Care to Dual Eligibles

Last week CMS announced that it would not execute its option to terminate its 2015 contracts with Medicare Advantage Plans and Part D plans that had scored three stars or less for three consecutive years. ...more

9/22/2014 - CMS Healthcare Medicare Medicare Advantage Medicare Part D

Prescription Drugs: Refocusing the False Claims Act Microscope on the Rest of the Transaction

Over the last decade, it has often felt as though the pharmaceutical industry has been the government’s and whistleblowers’ main, and at times only, target for False Claims Act (“FCA”) investigations. While manufacturers are...more

8/26/2014 - False Claims Act Medicaid Medicare Medicare Part D Pharmaceutical Pharmaceutical Manufacturers Pharmacies Prescription Drugs Walgreens Whistleblowers

Supreme Court: Closely-Held Corporations Are Protected by the Religious Freedom Restoration Act – Who Will Foot the Bill?

Monday morning, the U.S. Supreme Court announced its decision in the much anticipated Burwell v. Hobby Lobby case, holding that closely-held corporations are protected by the Religious Freedom Restoration Act of 1993...more

7/2/2014 - Affordable Care Act Burwell v Hobby Lobby Contraceptive Coverage Mandate Contraceptives Hobby Lobby Religious Exemption Religious Freedom Restoration Act SCOTUS

Notice to Plans and PBMs: Pay for Contraceptive Services and Maybe We Will Pay You Back

As has been widely covered in the news, regulations and guidance developed under the Affordable Care Act (“ACA”) require that non-grandfathered health plans make preventive care and screenings available to their members at no...more

2/18/2014 - Affordable Care Act Benefit Plan Sponsors Contraceptive Coverage Mandate Contraceptives Employee Benefits FDA Healthcare HHS

CMS Proposes Major Changes to Medicare Parts C and D

On January 10, the Centers for Medicare & Medicaid Services (CMS) published proposed rules labeled as “policy and technical” changes to the Medicare Advantage (Part C) and Medicare Prescription Drug Benefit (Part D) Programs....more

1/22/2014 - CMS Medicare Medicare Part C Medicare Part D

Caution: Risk Adjustment Hurdles Facing Plans and Providers Under the Affordable Care Act

January 1, 2014 is fast approaching and regulators, payor organizations, providers, and many other interested parties are working to implement, operationalize, and participate in the state-based American Health Benefit...more

7/22/2013 - Affordable Care Act Deadlines Delays Employer Mandates Health Insurance Exchanges Healthcare Pay or Play Shared Responsibility Rule

2014 Final Call Letter: CMS Raises Medicare Advantage Rates but Foreshadows Other Significant Program Changes

After receiving many comments on its Draft Call Letter, CMS published its Contract Year 2014 Final Call Letter on April 1, 2013. The Final Call Letter addresses a wide variety of issues that will affect all parties involved...more

4/17/2013 - Beneficiaries CMS Controlled Substances Medical Reimbursement Plans Medicare Advantage Modification Pharmacies Point of Sale Terminals Prescription Drugs Waivers

CMS Publishes 2014 Final Call Letter

Yesterday, CMS released its 2014 Final Call Letter for the Medicare Advantage and Medicare Part D programs....more

4/2/2013 - CMS Medicare Medicare Advantage Medicare Part D

DOJ Touts Active Enforcement of the False Claims Act in FY 2012

In a briefing earlier this week, Acting Associate Attorney General Tony West proudly reported that in FY 2012 the Department of Justice (DOJ) set a new single year record of nearly $5 billion in settlements and judgments...more

12/6/2012 - DOJ False Claims Act

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