Healthcare

News & Analysis as of

CMS Releases Hospital Inpatient PPS and Long-Term Care Hospital PPS Proposed Rule

CMS released updates to the Hospital Inpatient Prospective Payment System (Hospital IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) in a proposed rule on April 18, 2016 (Proposed Rule). The Proposed...more

NIH clinical center in Bethesda rebuked for failing to put patients first

A venerated research and care institution that happens to be in our neighborhood got a rebuke and a reminder about its need to put patients first, ensuring that their care doesn’t get trumped by research needs. A...more

Two Adverse Decisions against Church Plans Reached at Appellate Court Level

In Depth - Since 2013, there have been more than 10 lawsuits filed against various health care systems across the country that maintain and operate defined benefit pension church plans. These suits allege that the...more

CMS Announces New Alternative Payment Model for Primary Care

Earlier this week, CMS announced the launch of an initiative aimed at transforming the way primary care is delivered. The Comprehensive Primary Care Plus (CPC+) model will be a voluntary 5 year program accommodating some...more

Manatt on Health Reform: Weekly Highlights - April 2016 #2

California's Marketplace revises its QHP contract to improve care quality and value, and announces its support for a 1332 waiver to allow undocumented immigrants to purchase Marketplace plans; Wisconsin proposes transitioning...more

No Surprises in Recent Vested Rights Decision: Fry v. City of Los Angeles

The recent decision in Fry v. City of Los Angeles (California Second District Court of Appeal Case No. B259791, March 7, 2016) held, after careful parsing of the language in the City Charter and the applicable City...more

New Stark Law Exception Breathes Life into Primary Care, Especially in Underserved Areas

With the recent and significant shortages of primary care providers, the Centers for Medicare & Medicaid Services (“CMS”) recently created a rather important exception to the Stark Law as a means to expand access to primary...more

Difference of Medical Opinions Doesn’t Prove One Was False

A federal court in Alabama dealt a blow to the theory that in matters of medical judgment, a false claim action can rest on expert opinion evidence alone. A patient is eligible for hospice if the prognosis is life...more

FTC Wants to be a Champion for Telemedicine Providers

In a public comment supporting Alaska’s proposed telemedicine legislation, the Federal Trade Commission (FTC or Commission) reiterated its broad support for telemedicine services, quoting its own 2004 analysis: “When used...more

To Refer, Or Not To Refer? OIG’s Outdated Health Care Referral Restrictions

The Office of the Inspector General, which enforces Health and Human Services, has long been averse to referral services that don’t meet certain criteria. To get protection against a possible enforcement action, the referral...more

Program Integrity Changes to the Medicare Provider Enrollment Process

On March 1, 2016, the U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services (CMS) published a proposed rule (Proposed Rule) entitled “Medicare, Medicaid, and Children’s Health Insurance...more

Federal Government Recovers $3.5 Billion from False Claims Cases in 2015

The United States Department of Justice has announced that it has recovered over $3.5 Billion from cases brought under the False Claims Act (FCA) in fiscal year 2015. This significant aggregate recovery is a slight decline...more

Update: Is This The Year Florida Recognizes Direct Primary Care?

House Bill 37 (“HB 37”) passed the Florida House 116-0 today. In a hostile political environment, the unanimous vote in Florida’s more conservative chamber confirms what many in the direct primary care medical (“DPC”) space...more

What the President's FY 2017 budget request says about GME

On February 9, 2016, the Obama administration released its fiscal year (FY) 2017 budget request. Released on an annual basis, the President's budget request generally plays three key roles in shaping federal policy...more

SC Public Policy Update - February #4

SENATE - The filibuster on the South Carolina Infrastructure Finance Reform and Tax Relief Act (H.3579) continued this week in the Senate. Senator Tom Davis (R-Beaufort) filibustered over eleven hours Tuesday and...more

Minnesota Legislative Update: 2016 Legislative Session Preview 02/2016

The second year of the 89th Session of the Minnesota Legislature convenes on March 8, 2016. This year’s session is unusually late and will last an atypically short 11 weeks. The February Forecast released today projects...more

Health Alert: CMS and AHIP Announce New Clinical Quality Measures

On February 16, 2016, the Centers for Medicare & Medicaid Services (CMS) and America's Health Insurance Plans (AHIP), in collaboration with physician groups and other stakeholders, released seven sets of clinical quality...more

Health Care: What's on the Radar for This Congressional Work Period

The next Hill work period basically runs from February 22 to March 18. As Congress returns, here’s a brief look at the pending health care issues on the radar for this work period....more

CHINA REGULATORY ENFORCEMENT QUARTERLY - Q4 2015

Legal and regulatory developments in Q4 2015 continue to reject attempts by the Chinese government to respond to the significant challenges presented by the slowing market economy and other domestic crises, while the country...more

Leading Private Equity Firms That Invest in Healthcare (Part I)

In the past decade, the list of investors that have put their capital to work in the healthcare and life sciences industries has grown dramatically. Healthcare and life sciences offer some undeniable opportunities that...more

Healthcare Regulatory Diligence: “What Does it Mean to Financial Underwriting?”

It’s deal time! The 2016 JP Morgan Healthcare Conference has set the tone for another successful year for healthcare investing. A company’s financial health is a key factor in the underwriting process for any type of loan...more

U.S. Departments of Education and Health and Human Services Issues Joint Policy Letter On Improving School-Based Health

The United States Departments of Education and Health and Human Services (the “Departments”) recently issued a joint policy letter emphasizing the importance of improving school-based health through the use of partnerships...more

Antitrust: “Doctor, Doctor, Give Me the News”* Court gives Teladoc some good news in its antitrust challenge to Texas Medical...

Back in April 2015, Teladoc, Inc., which provides U.S. board-certified doctors for consults via phone or online video, filed an antitrust challenge to stop a new Texas Medical Board (TMB) rule from taking effect that requires...more

FDA Not Sure About Essure

Medical doctors have a great deal of responsibility placed upon them. After years of training and practice, they are expected to have the skill and ability to identify symptoms and translate that into a diagnosis. That...more

CMS Issues Final Rule Implementing Mandatory Bundled Payment Program for Lower Extremity Joint Procedures

The Centers for Medicare & Medicaid Services (CMS) recently issued a final rule (Final Rule) that implements the Comprehensive Care for Joint Replacement model (CJR Model), a new bundled payment program covering certain...more

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