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Health Updates

Read need-to-know updates, commentary, and analysis on Health issues written by leading professionals.

CMS revises CJR program, cancels cardiac bundles

by Thompson Coburn LLP on

On Aug. 15, 2017, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule seeking to reduce mandatory participation requirements in the Comprehensive Care for Joint Replacement (CJR) program for hospitals...more

Implied False Certification Theory Fails in FCA Case Against Billing Agent

A court in the Southern District of New York (“SDNY” or the “Court”) recently released an important decision applying the Supreme Court’s landmark Escobar ruling to a qui tam action involving percentage fee arrangements for...more

CMS Cancels EPM and Cardiac Rehabilitation Incentive Program While Revising CJR in New Proposed Rule

by Baker Ober Health Law on

After initially delaying the implementation of Episode Payment Models (EPMs) earlier this year, CMS issued a Proposed Rule on August 17 that proposes to cancel all EPMs and the Cardiac Rehabilitation Incentive Program (CR)...more

The Four Things That Surprised Us in the EpiPen False Claims Settlement

On August 17, 2017, the U.S. Department of Justice (DOJ) announced that it had reached a $465 million false claims settlement with Mylan, the manufacturer of EpiPen, over the company’s alleged underpayment of Medicaid Drug...more

Court Throws Monkey Wrench Into Wellness Programs

The U.S. District Court for the District of Columbia has ordered the EEOC to reconsider its final regulations on the extent to which an employer may offer incentives to participate in a wellness program without violating the...more

The FDA's new Digital Health Plan

by Thompson Coburn LLP on

The US Federal Food and Drug Administration (‘FDA’ or ‘Agency’) Commissioner Dr Scott Gottlieb has used an FDA blog post to announce plans for a new digital health devices initiative, specifically the initiative’s Digital...more

Ministry of Justice regulates the medical and scientific use of cannabis

by Dentons on

Through Resolutions 577–579, issued on August 8, 2017, the Ministry of Justice has regulated matters relating to (i) the evaluation and monitoring of licenses for the seeding and cultivation of cannabis plants, (ii) the...more

Reminder: Medical Providers Must Be Attentive to Credit Balances and Other Overpayments

It has now been a number of years since the enactment of Section 6402(a) of the Affordable Care Act ("ACA"), which requires among other things that any recipient of a Medicare or Medicaid overpayment report and return it...more

Update on Cost-Sharing Reduction (CSR) Payments and Graham-Cassidy-Heller Proposal

by King & Spalding on

According to multiple media reports, the Trump administration will make CSR payments for August. President Trump has previously called these expenditures, which help insurers fund coverage for low income individuals,...more

THE LATEST: Rate-for-Volume Payer Contract Provision Should Be Analyzed under Rule of Reason

by McDermott Will & Emery on

District Judge Walter H. Rice of the Southern District of Ohio granted three pretrial motions brought by the Defendants on the eve of trial in The Medical Center at Elizabeth Place, LLC v. Premier Health Partners, et al.,...more

Recent HHS Activity Following International Cyber Attacks

by Steptoe & Johnson PLLC on

Following recent international cyber attacks, the U.S. Department of Health and Human Services (HHS) has issued warnings to healthcare organizations, provided a cyber attack checklist, and launched its revised HIPAA Breach...more

Medicare Claims Appeals: D.C. Circuit Reverses and Remands in Case Seeking Relief From Processing Delays

by Foley & Lardner LLP on

On August 11, 2017, the D.C. Circuit reversed the district court and held that the district court abused its discretion by ordering the Secretary of HHS to clear the backlog of administrative appeals of denied Medicare...more

Updates to National Plan and Provider Enumeration System (NPPES) Impact Physicians, Providers, and Suppliers

by Arnall Golden Gregory LLP on

The Centers for Medicare & Medicaid Services (CMS) recently updated the National Plan and Provider Enumeration System (NPPES), which impacts all physicians, providers, and suppliers that use NPPES to obtain or maintain a...more

Bad News for Whistleblowers: Defendant Pleads Guilty

by Faegre Baker Daniels on

At first glance, it looks nonsensical. How could it be bad news for False Claims Act whistleblowers that the defendant pleaded guilty to violating that statute—to committing the very Medicare fraud the whistleblowers alleged?...more

K&L Gates Triage: 340B Regulatory Update: CMS Proposal and Draft Executive Order Could Have Big Impact on 340B Program

by K&L Gates LLP on

cmsThis episode outlines the basics of the 340B Drug Pricing Program and discusses potential changes affecting the program, including CMS’s recent proposal to cut reimbursement for Part B drugs purchased under the 340B...more

K&L Gates Triage: 340B Eligibility - Hospital Covered Entities

by K&L Gates LLP on

This podcast focuses on the eligibility requirements for hospitals participating in the 340B Drug Pricing Program. Factors affecting eligibility include a hospital’s licensure status, patient population, and Medicare...more

Recent Events Increase the Importance of HIPAA Risk Analyses and HIPAA Policies

Recent events highlight the fact that threats to customer and patient data continue to increase. In recent months, government agencies, news outlets, and others have spent considerable time investigating and reporting on...more

No Weingarten Rights For Nurses In Peer Review Proceeding, Federal Appeals Court Rules

by Jackson Lewis P.C. on

Nurses had no right to union representation in their hospital employer’s peer review committee proceedings, the Court of Appeals for the District of Columbia Circuit has ruled. Midwest Division – MMC, LLC, dba Menorah Medical...more

CMS Proposes to Cancel Bundled Payment and Incentive Models

The U.S. Centers for Medicare & Medicaid Services (CMS) published a proposed rule last week regarding the cancellation of three bundled payment models and an incentive payment model while also reducing the scope of a third...more

Health Alert (Australia) 22 August 2017

by DLA Piper on

In This Issue: - Judgments; Legislation; and Reports. - Excerpts from Judgments: 11 August 2017 - South Western Sydney Local Health District v Sorbello [2017] NSWCA 201 - NEGLIGENCE – assessment of damages...more

The Ninth Circuit Weighs in on ERISA’s Plan Document and Summary Plan Description Requirements: Mull v. Motion Picture Ind. Health...

Mull v. Motion Picture Ind. Health Plan educates employers on the basics of the requirements of the Employee Retirement Income Security Act (ERISA) governing plan documents and summary plan descriptions. The lessons are...more

Value-based health care: provider integration

by Ropes & Gray LLP on

John Chesley, Ropes & Gray health care partner, addresses developments for providers to consider as they join together and move towards value-based health care models....more

CMS Proposes to Cancel Episode Payment Models, Cardiac Rehab Incentive Payment Model and Revise Comprehensive Care for Joint...

by King & Spalding on

On August 15, 2017, CMS announced a proposed rule to cancel the Episode Payment Models (EPMs) and Cardiac Rehabilitation (CR) incentive payment model scheduled to begin January 1, 2018, and to rescind the regulations...more

GHA Implements Georgia Rural Hospital Expense Tax Credit Program for Employees

by Arnall Golden Gregory LLP on

In 2016, the Georgia Legislature passed the Rural Hospital Tax Credit Program that provides a state income tax credit that is designed to encourage Georgians to financially contribute to qualified rural hospital...more

Dealing With the ‘AR Dump’: Don’t Accept the Spreadsheet

by McGuireWoods LLP on

“AR dump” cases involving thousands of medical claims are on the rise. The standard playbook is for the provider to run its accounts receivable report and file a summary complaint or arbitration demand alleging the total...more

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