David Dirr

9th Circuit Tells CMS It's Wrong, Again.

In a unanimous decision this month (July 2013), the Ninth Circuit Court of Appeals ruled that federal Medicaid law prohibited California from cutting a variety of healthcare services, including adult dental, podiatry, and…more

| Health

Health Insurance Exchanges 101

State health insurance exchanges, which will be operational by October 1, 2013, form one of the building blocks of the Affordable Care Act (ACA). Although there are already, and will soon be more, very detailed rules and…more

| Health

Supreme Court Case Could Alter Ohio Medicaid Lien Law

A decision this spring in U.S. Supreme Court case of Delia v. E.M.A. could affect how Ohio and other states recoup their Medicaid costs from the recoveries of Medicaid beneficiaries in tort litigation. In Delia v. E.M.A., the…more

| Civil Procedure, Health

DOJ Sets Another Record in Healthcare Fraud Recoveries

The United States Department of Justice (DOJ) again broke a record by recovering approximately $3 billion under the False Claims Act in healthcare fraud and abuse cases in the 2012 fiscal year. This new record shatters the…more

| Health

Class-Action Settlement Will Change Medicare Rules

A proposed settlement of a national class-action lawsuit should make it easier for people with chronic conditions and disabilities to qualify for Medicare coverage for home healthcare services, skilled nursing care, and therapy…more

| Health

Changes Coming for Medicare Set-Aside Arrangements

The law governing Medicare Set-Aside Arrangements (“MSAs”) in personal injury liability lawsuits may soon be changing. In personal injury liability cases, MSAs are funds from a judgment or settlement allocated to cover the…more

| Health, Personal Injury

Malpractice Lawsuits Are Lengthy, But Physicians Often Prevail

In a study released in May 2012, researchers found that physicians successfully defended mot of the medical malpractice lawsuits against them. Researchers examined more than 10,000 malpractice claims across the United States…more

| Civil Procedure, Professional Malpractice

Court Decides Not to Decide Medicaid Case

The U.S. Supreme Court's much-anticipated decision on whether Medicaid providers can challenge state Medicaid rates in federal court turned out to be a dud. The decision concerned the case of Douglas v. Independent Living…more

| Health

Hospitals See Medicare Payments Increase Under Final Rule

General acute care hospitals were relieved to learn that under the Fiscal Year 2012 Inpatient Prospective Payment System (IPPS) Final Rule, they will see an increase in payments by 1% in fiscal year 2012, rather than the .5%…more

| Health

New Legal Waivers for ACOs

In the spring of 2011, the Centers for Medicare and Medicaid Services (CMS) released the proposed rules governing Accountable Care Organizations (ACOs) participating in the CMS Shared Savings Program. Many providers felt CMS…more

| Health

Supreme Court Could End Medicaid Appeals

In October of 2011, the Supreme Court heard oral arguments in a case that could eliminate the ability of providers and Medicaid beneficiaries to challenge state Medicaid rates in federal courts. The case is a consolidation of…more

| Health, Insurance

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