News & Analysis as of September 20, 2024

Fraud and Abuse

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The Patient Protection and Affordable Care Act (PPAC), also known as Obamacare, is a United States federal statute passed in March of 2010. The Act creates a nationwide insurance system and provides federal... more +

Healthcare Fraud & Abuse Review 2017

Bass, Berry & Sims PLC on 3/13/2018

A LOOK BACK... A LOOK AHEAD - While the uncertainty associated with legislative efforts to repeal the Patient Protection and Affordable Care Act (PPACA) dominated most of the headlines for the healthcare industry last year,...more

Manatt on Health Reform: Weekly Highlights - May 2017 #4

Manatt, Phelps & Phillips, LLP on 5/24/2017

The President's budget proposes over $600 billion in Medicaid cuts on top of major reductions anticipated in repeal and replace legislation; the Trump Administration asks the Court for more time to decide on cost-sharing...more

CMS Creates Clarity and Confusion on Application of Fraud and Abuse Laws to Qualified Health Plans

Manatt, Phelps & Phillips, LLP on 11/13/2013

On October 30, 2013, U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius sent a letter to U.S. Representative Jim McDermott stating that HHS does not consider qualified health plans (QHPs) sold...more

Medicare Enrollment Moratoria: Implications for Service Expansion and Certain Transactions

Baker Donelson on 9/9/2013

One of the provisions of the Affordable Care Act provided CMS with the authority to impose a temporary enrollment moratorium for a particular type of provider or supplier if determined to be necessary to combat fraud and...more

Ordering/Referring Phase 2 Begins May 1st - Claims Will Be Denied

Baker Donelson on 3/30/2013

In an April 24, 2009 transmittal, CMS announced a two-phase claims editing expansion designed to allow verification that the physician or non-physician practitioner (NPP) listed as the ordering/referring provider on a...more

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