Medical Reimbursement

News & Analysis as of

Healthcare Providers Face Increasing Financial Pressure and Bankruptcy Risk

The health of the healthcare industry can be summarized as follows: as go federal reimbursement rates, so goes the financial viability of healthcare providers, whether hospitals, nursing homes or medical practices. These...more

Top 5 takeaways on telemedicine and eHealth

Here are the main legal topics on telemedicine and eHealth discussed during the ETSI eHealth Workshop on telemedicine where I gave a speech on the legal implications of telemedicine. The Workshop was very interesting...more

New Development Regarding Medicaid STAR+PLUS Network Provider Agreements for Texas Nursing Homes

Beginning this fall, Texas nursing home reimbursement will be converted to Medicaid Managed Care. In preparation for the Medicaid Managed Care rollout, Texas Managed Care Organizations ("MCOs") recently sent out network...more

Never Fear Regulatory Violations – Focus on Conditions to Payment

The U.S. Court of Appeals for the Fourth Circuit recently upheld the dismissal of a False Claims Act (FCA) suit against Omnicare, Inc., in which the relator alleged that certain drugs repackaged by Omnicare’s subsidiary were...more

Plan C for Your Plan B - Using Excepted Benefits to Maximize Cost Savings under Obamacare for Small Businesses: Non-Coordinated...

Overview - The Godfather trilogy is one of my favorite movie series. My mother was Italian American with both parents from the Old Country. What is the connection between these Oscar winning films and Obamacare?...more

Medicare Contractors Receive CMS Direction Regarding Recalcitrant Providers

CMS recently issued a transmittal providing guidance to Medicare program contractors on when and how to refer certain “recalcitrant providers” to CMS for potential sanctions under the Office of Inspector General’s (OIG) civil...more

Modification of “Use It or Lose It” Rule for Health Flexible Spending Arrangements

The Internal Revenue Service recently issued new guidance modifying the “use it or lose it” rule applicable to health flexible spending arrangements (FSAs) to allow carryover of certain unused health FSA amounts into the next...more

Court Sides With CMS Stark Regulations on Physician-Owned Under Arrangement Service Providers

On May 24, the U.S. District Court for the District of Columbia in Council for Urological Interests v. Sebelius1 (‘‘CUI’’) sided with the Centers for Medicare & Medicaid Services in a lawsuit brought by a group of urologists...more

Expanding Access to, and Development of, Personalized Medicine

In a July 8th, 2013 letter to the Centers for Medicare & Medicaid Services (CMS), the Personalized Medicine Coalition (PMC) advised that proposed reimbursement schedules for diagnostic medicine will threaten the development...more

Doctors Going To Jail: Criminal Prosecutions For Quality Of Care And Fraud

When I was growing up (and probably for generations), every proud parent wanted their son or daughter to go to medical school....more

Managing Peer Review Investigations: How to Avoid Hearings and Litigation

In this presentation: - Provide recommendations regarding best practices, bylaw provisions and other strategies to address and resolve quality and peer review issues without resorting to “investigations” and...more

Health Care Reform Blog: IRS Proposes Additional Minimum Value Rules

Last Friday the IRS released additional proposed regulations implementing the minimum value requirement for coverage sponsored by employers with 50 or more FTEs. The proposed rules provide that amounts contributed by...more

Hospital-Physician Mergers: Practical Issues and Steps to Minimize Antitrust Risk

Recently, hospitals have been actively acquiring primary care and specialty physician groups, resulting in the employment of those physicians. This trend has occurred largely in response to reimbursement changes and other...more

Court of Appeals Rules for Government in DSH Exhausted Benefit Day Appeal

For the last several years, hospitals and the government have fought hard over where days associated with certain “dual eligible” patients should be placed in the Medicare disproportionate share hospital (DSH) calculation. At...more

Hospitals And Fraud Enforcement

The HHS Office of Inspector General has targeted hospitals for fraud enforcement. It is one of the OIG’s most important initiatives because of the impact it could have on reducing health care costs....more

The ERISA Litigation Newsletter - December 2012

In This Issue: - Editors' Overview - Supreme Court Revisits Meaning of 'Appropriate Equitable Relief' in US Airways v. McCutchen - Rulings, Filings, and Settlements of Interest ...more

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