News & Analysis as of

Is Health Care Fraud on the Rise? Or Just the Accusations??

Recent stories in the news seem to suggest that health care fraud is running rampant. We’ve got stories about Eric Leak‘s Medicaid agency, Nature’s Reflections, funneling money to pay athletes, a seizure of property in...more

Manatt on Health Reform: Weekly Highlights - March 2015 #4

This week, Alaska’s Governor introduced Medicaid expansion bills in both the House and Senate after failing to get approval in his budget. Colorado determined that non-ACA-compliant plans cannot be sold in 2016, a year ahead...more

Health Care E-Note - March 2015

In This E-Note: - Health Care Reform in America: The Good, The Bad and The Ugly - The Federal False Claims Act - Violations of Conditions of Payment or Conditions of Participation? - State Regulatory...more

CMS Posts Initial Results for Physician Value-based Payment Modifier

Under the ACA, the Physician Value-Based Modifier (Value Modifier) policy rewards physicians and groups of physicians who provide high quality and cost effective care, while penalizing those who did not meet objectives. ...more

Health Care Update - March 2015 #3

In This Issue: - Permanent Medicare Doc-Fix Could be a Reality, CHIP Reauthorization May Be Lynchpin - Implementation of the Affordable Care Act - Other Federal Regulatory Initiatives -...more

Next Generation ACOs: CMMI Doubles Down on the Two-Sided Risk ACO Model

While one part of the Affordable Care Act, exchange subsidies, hangs in the balance with the Supreme Court’s upcoming decision in King v Burwell, CMS is moving forward aggressively with the evolution of a less controversial...more

Health Care Update - March 2015 #2

In This Issue: - Senate HELP Begins Innovation for Healthier Americans Hearings - 340B Hearing Postponed; Written Testimonies Shed Light on Agenda - Implementation of the Affordable Care Act -...more

Health Care Update - March 2015

In This Issue: - King v. Burwell before the Supreme Court and the Potential Congressional Response - Implementation of the Affordable Care Act - Other Federal Regulatory Initiatives - Congressional...more

The Unhappy Intersection of Hospital Mergers and Antitrust Laws

The rapidly-evolving field of health care has been moving lately towards a single-minded goal – coordination of patient care in the name of efficiency and efficacy. Hospital systems are more and more often merging with other...more

DOJ and FTC Announce Proactive Approach to Monitoring Post-Affordable Care Act Antitrust Compliance at Joint Workshop

On February 24 and 25, the DOJ and FTC held their second joint workshop to examine the state of health care competition in the United States. The workshop explored five main themes: early observations regarding accountable...more

FTC and DOJ Host Workshop Examining Health Care Competition - Updated 2015

The Federal Trade Commission (FTC) and the Antitrust Division of the U.S. Department of Justice (DOJ) held a public workshop on February 24–25, 2015, to examine recent trends and developments in health care provider...more

Medicaid Managed Care: What’s Ahead in 2015

Managed care is the dominant delivery model in state Medicaid programs, and is rapidly growing with the Affordable Care Act bringing over 8 million new beneficiaries into Medicaid in 2014. Today, 39 states (including the...more

60 Day Rule

The Patient Protection and Affordable Care Act of 2010 (“ACA”) requires a provider of services, supplier, Medicaid Managed Care Organization, Medicare Advantage Organization, or Prescription Drug Plan Sponsor receiving an...more

On the Eve of Oral Arguments before the U.S. Supreme Court in King v. Burwell: Obamacare in the Balance

As every healthcare geek and Supreme Court wonk will tell you, on March 4, the U.S. Supreme Court will hear oral argument in King v. Burwell (an amalgamation of four cases – King v. Burwell, Halbig v. Burwell, Pruitt v....more

Temporary Waiver of ACA Penalties for Small Employers’ Individual Insurance Premium Reimbursement Plans

Last week, the IRS announced the waiver (for 2014 and the first half of 2015) of the penalty for “small” employers that reimburse employees for individual health insurance premiums. To the IRS, “small employer” means an...more

The Importance of HPSA and MUA Designation

Rural communities in Kentucky are still largely underserved by health care providers. With the expanded range of Medicaid and Medicare services now available as a result of the Patient Protection and Affordable Care Act...more

Washington Healthcare Update

This Week: Upcoming Hearing: HHS Sec. Burwell Appearing Before E&C Committee on FY2016 Budget... CMS Issues 2016 Payment and Policy Updates for Medicare Health and Drug Plans... CMS Releases Improved Rating System for Nursing...more

OIG Report Outlines Five Recommendations for Hospice Care Reform

The Patient Protection and Affordable Care Act requires the Centers for Medicare and Medicaid Services (“CMS”) to reform the hospice payment system, collect data relevant to revising hospice payments and develop quality...more

Health Care Update - February 2015 #2

In This Issue: - Open Enrollment Update - Implementation of the Affordable Care Act - Other Federal Regulatory Initiatives - Congressional Initiatives - Other Health Care News -...more

Washington Healthcare Update

This Week: Energy and Commerce Hearing Examines ICD-10 Preparedness... HHS Announces Oncology Care Model Initiative... Pennsylvania Governor Abandons Alternative Medicaid Expansion Approach for Traditional Plan....more

GAO Highlights Medicare Program Risks and Recommends Program Integrity Actions

The Government Accountability Office (GAO) has released its latest update to its “High-Risk Series” reports, which again lists Medicare as a high-risk program, in part because of the program’s substantial size and scope, and...more

Implications of Final Regulations Under Internal Revenue Code Section 501(r)

The Internal Revenue Service replaced proposed regulations under Section 501(r) of the Internal Revenue Code (the “Code”) with final regulations in late 2014 (the “Final Regulations”). As enacted in the Patient Protection and...more

Manatt on Health Reform: Weekly Highlights - February 2015 #2

HHS ramps up for the final week of open enrollment. Families buying into CHIP in Pennsylvania are granted tax relief, and though Medicaid expansion efforts seem to have hit a wall in Tennessee and Wyoming, Arkansas assures...more

Obama Administration Releases FY 2016 Budget Proposal with Medicare/Medicaid Provisions

On February 2, 2015, the Obama Administration released its proposed federal budget for fiscal year (FY) 2016. The budget would impact all types of health care providers, health plans, and drug manufacturers if adopted as...more

Manatt on Health Reform: Weekly Highlights - February 2015

The President’s budget reveals the healthcare agenda for his Administration’s penultimate year. Medicaid expansion proposals advance in Arkansas and Wyoming; California’s Marketplace reports 9 out of every 10 enrollees remain...more

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