News & Analysis as of

Health Care Providers Patient Protection and Affordable Care Act (PPACA)

Why Isn’t My “Free” Preventive Health Care Free?

by Snell & Wilmer on

In my opinion, one of the best changes made by the Affordable Care Act is the mandate that requires health plans to provide certain specified preventive services without imposing any cost sharing. This is sometimes referred...more

Value-based health care: fraud & abuse laws

by Ropes & Gray LLP on

Michael Lampert, Ropes & Gray health care partner, discusses fraud and abuse law application to value-based health care arrangements. __ Much has been made about how the fraud and abuse laws, which were designed in order...more

Preventing Overpayments from becoming False Claims

by Dickinson Wright on

Overpayments to healthcare providers receiving Medicare reimbursements are at risk of civil and criminal enforcement action if not attuned to a particular reimbursement rule and diligent in compliance with the rule’s...more

Code Red: Healthcare Restructurings on the Rise

Financial distress – sometimes it is isolated to specific borrowers and other times, it is endemic within an industry. In recent years, energy (e.g., oil, gas, and coal), retail and other industries have suffered widespread...more

Post-Acute Care Summary Report - May 2017

by Benesch on

PE Firms Look Past Uncertainty in Healthcare Market—For Now - The outlook for the healthcare industry remains unclear, thanks in large part to continued changes ushered in by the Affordable Care Act (ACA) and uncertainty...more

Outlook 2017 Teleconference: Revisiting the Trump Administration’s Impact on Life Sciences and Health Care—the First 100 Days

by Ropes & Gray LLP on

On Tuesday, May 2, Ropes & Gray hosted a teleconference, “Outlook 2017 Teleconference: Revisiting the Trump Administration’s Impact on Life Sciences and Health Care – the First 100 Days,” on the potential regulatory and...more

Capitol Hill Healthcare Update

by BakerHostetler on

Congress’s official budget scorekeepers this week will release analysis of the House-approved bill repealing most of the Affordable Care Act (ACA), and that data will inform Senate Republicans on a path for passing their...more

Three Things Health Care Employers Should Know About Affordable Care Act Section 1557

by Baker Ober Health Law on

Health care providers are likely familiar with the Affordable Care Act's (ACA) prohibitions on discriminating against the recipients of their services, but providers also must be mindful that the ACA may also make them...more

Ten Things Investors Need to Know About Value-Based Healthcare

by Ropes & Gray LLP on

This article highlights key business and legal issues related to value-based healthcare for investors considering opportunities in the healthcare industry. 1. Value-Based Arrangements Are Here to Stay Value-based...more

AGG Takeaways from 2017 AHLA Health Care Transactions Conference

The annual AHLA Health Care Transactions Conference provides valuable insights into transaction strategies, commercial developments, and legal issues affecting contemporary health care transactions, as well as unique...more

Repayment and Self Disclosure of Known Overpayments

by Ruder Ware on

The 60-day repayment rule adopted as part of the Affordable Care Act is a very strong arrow in the quiver of federal enforcement agencies. Under the 60-day rule a known overpayment can become a False Claim if it is not repaid...more

Stark Law: What Providers Should Know About New CMS Form

by Polsinelli on

The Centers for Medicare and Medicaid Services (CMS) has finalized Form CMS-10328 (the SRDP Form), a new OMB-approved information collection instrument that must be used by providers and suppliers utilizing the Stark Law...more

New Director at HHS OCR Sets the Stage for Enforcement of Section 1557

The Department of Health and Human Services Office of Civil Rights (HHS OCR), the office tasked with enforcing Section 1557 of the ACA, has a new Director and Deputy Director for Civil Rights. The new Director, Roger...more

Insiders Say New MACRA Rule Likely as Providers Look to Sec. Price to Ease Burden

The Trump administration is considering releasing a rule to ease the burden that small practices are facing in trying to comply with the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), according to a recent...more

CY 2018 Medicare Advantage Final Call Letter

The most recent MA Call Letter, “Announcement of Calendar Year (CY) 2018 Medicare Advantage Capitation Rates and Medicare Advantage and Part D Payment Policies and Final Call Letter and Request for Information” (Call Letter)...more

2017 Nevada Legislative Session – Potential for Additional Anesthesiology Practice Opportunities in Nevada

by Snell & Wilmer on

On February 27, 2017, Senate Bill 210 (“S.B. 210”) was introduced into the Nevada Legislature, which paves the way for expanded anesthesiology practice and patient care opportunities in the State of Nevada....more

How Will the Trump Administration Impact Healthcare Litigation?

Editor's Note: In a dramatic conclusion to the heated debate surrounding the American Health Care Act (AHCA), the bill was withdrawn after it became clear that House leadership did not have enough votes to pass it. There is...more

Proving Utility, Demonstrating Value: How to Align the Moving Parts in Personalized Medicine Reimbursement

by Foley & Lardner LLP on

Of the many business, operational, legal, regulatory and clinical obstacles standing in the way of widespread delivery of personalized medicine, the single greatest challenge may lie in solving the reimbursement puzzle....more

HHS Finalizes Rule Aimed at Stabilizing ACA Individual Marketplace

by Baker Ober Health Law on

On Thursday, April 13, the Department of Health and Human Services finalized a long-awaited regulation intended to stabilize the Affordable Care Act (ACA) individual health insurance marketplace. The final rule tracks closely...more

New OIG Rules Change Patient Incentive Program Landscape: Where Are the Limits Now?

by McDermott Will & Emery on

With health care becoming more consumer-driven, health care providers and health plans are wrestling with how to incentivize patients to participate in health promotion programs and treatment plans. As payments are...more

Legislative Solutions: 2017 Virginia Legislative Recap

by Williams Mullen on

The following is a summary of key legislation impacting the health care industry in Virginia. Reforming or Repealing Virginia’s Certificate of Public Need Program - The study of the COPN process continues -...more

Does Defensive Medicine Impact the Cost of Healthcare?

by Snell & Wilmer on

Healthcare in the United States costs at least two to three times as much as healthcare in other developed countries. One of the reasons usually given is defensive medicine – doctors who order unnecessary tests and procedures...more

Deaf Individuals Sue Health System for Discrimination Under Section 1557 of the ACA

by Arnall Golden Gregory LLP on

This month, twelve deaf individuals filed a federal suit against Banner Health in Arizona alleging discrimination under Section 1557 of the ACA because of an alleged failure to provide effective auxiliary aids. Specifically,...more

Third-Party Payment of Premiums: Controversy and HHS Guidance

Since the passage of the Affordable Care Act (ACA), the payment of healthcare premiums by third parties has been the subject of controversy. As Congress develops its plan to repeal and replace the ACA, it is uncertain how...more

States May See Earliest Opportunities to Alter Health Care Landscape

by Epstein Becker & Green on

While the titans on Capitol Hill clash over the best answer to the Affordable Care Act (ACA), the Trump administration is promoting action at the state level that could produce meaningful impact soon. Health industry...more

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