News & Analysis as of

Annual Penny-Wise, Pound-Foolish Award Winner Announced

When it comes to the annual Penny-Wise, Pound-Foolish Award, don’t ever bet against the United States Congress. This year, Congress lay back in the weeds until the year was almost over before making its move for the trophy. ...more

Manatt on Health Reform: Weekly Highlights: December 2014 #3

Enrollment numbers and Medicaid reform top the news this week. Federal officials report 1.4 million consumers have selected plans on healthcare.gov. And in the states, Michigan and New Hampshire announce Medicaid expansion...more

OIG Report: MCOs Cause Limited Access to Primary Care for Medicaid Enrollees!

With flu season well under way, access to care to primary care physicians for Medicaid recipients is (as it is always) extremely important. During flu season, in particular, emergency rooms (ERs) are full of people suffering...more

The Future of MassHealth: Five Priority Issues for the New Administration

Executive Summary - The past decade marked an era of seismic change in the Massachusetts health care market and one in which the Commonwealth led the nation in coverage and delivery system reform. In 2006,...more

CMS Clarifies Definition of Uninsured Under the Hospital-Specific Limitation on Medicaid DSH Payments

On Friday, November 28, 2014, CMS issued a Final Rule providing that, for purposes of the hospital-specific limitation on Medicaid disproportionate share hospital (DSH) payments, the definition of “uninsured” will now be...more

Impact of Health Care Reform on Provider Liability

In this presentation: - The Changing Healthcare Landscape - Key Features of an ACO/CIN - ACO Standards and Quality Metrics - Examples of Quality Standards - Impact on Board and Corporate...more

Seventh Circuit Limits the Use of the Federal Assignment Law under the False Claims Act

It’s common in the healthcare industry for large insurers to negotiate discounts from pharmacies for prescription drugs. The federal government, the granddaddy of all insurers, does this too, when it negotiates discounts on...more

Health Care Update - November 2014 #3

In This Issue: - 21st Century Cures Remains Top Bi-Partisan Priority for 2015 - Senate Passes Critical Access Hospital Direct Supervision Bill - Implementation of the Affordable Care Act - Other...more

Health Law Pulse - November 2014

In This Issue: - Connecticut Supreme Court: HIPAA Does Not Preempt Negligence Claims - CMS Removes Continuing Education Exemption to Physician Payments Sunshine Act - Federal Government and New York...more

Post-Acute Care Summary Report - 2014: Benesch Health Care Market Intelligence

In this Issue: - Key Findings - Subsector Activity - Regulatory/Legal - Reimbursement - Excerpt from Key Findings: • The post-acute care (PAC) sector has seen an increase in mergers...more

Impact of Midterm Elections on Health Care

The November 4 elections saw the Republican party win control of the U.S. Senate, increase its majority in the House of Representatives, and increase its majority of governorships....more

The Government Is Going to Take My Money (and Other Medicaid Myths)

Due to ever-increasing nursing home costs, many clients have contacted us about Medicaid eligibility. Medicaid is a government program designed (in part) to pay the cost of nursing home care for those who need long-term care...more

North Carolina Legislative Report

The General Assembly adjourned “sine die” on Wednesday, August 20. During the interim, the MVA Public Affairs Legislative Report on North Carolina will be distributed biweekly to keep you up to date on the latest legislative...more

Another Halloween Treat: the OIG’s 2015 Work Plan

On Halloween the Office of Inspector General (OIG) of Health & Human Services released its “Work Plan Fiscal 2015.” The 90-page document is meant to tell the public, and especially health care providers paid by Medicare and...more

Deadline Approaching to Secure Health Plan Identifier (“HPID”)

Certain group health plans are required to obtain a 10-digit Health Plan Identifier ("HPID") from the Center for Medicare and Medicaid Services ("CMS") by November 5, 2014. Currently various users of the health care system...more

U.S. Accuses NYC of Massive Fraud in Program for Developmentally Challenged Toddlers

It’s the city that never sleeps. So when it does something, it can do it in a big way. That applies to Medicaid fraud, according to a suit filed yesterday by the U.S. Attorney for the Southern District of New York....more

Blurring the Lines between False Claims Act Litigation and Putative Federal Malpractice Law: The DOJ Quietly Invokes “Worthless...

On October 10, 2014, the United States Department of Justice (“DOJ”) announced a civil settlement agreement (the “Settlement”) with Extendicare Heath Services, Inc. and its subsidiary Progress Step Corporation (collectively,...more

Manatt on Health Reform: Weekly Highlights

Welcome to the first publication of the “Manatt on Health Reform: Weekly Highlights” newsletter. Many of you are familiar with the healthcare reform tracking efforts and weekly newsletters we produced for the KidsWell...more

Seventh Circuit Reaffirms Worthlessness of Worthless Services Cases

In August the Seventh Circuit expressed its view that so-called “worthless services” cases don’t state a claim under the False Claims Act. Last Friday the court reaffirmed its view by refusing to rehear the case en banc....more

OIG Proposed Anti-Kickback Safe Harbors and CMP Regulations: The End of Frustration or Just the Beginning?

On October 3, 2014, the U.S. Department of Health and Human Services Office of Inspector General (OIG) published an unexpected, yet long-awaited, set of proposed rules that would add new anti-kickback law safe harbors,...more

Medicaid ACOs: States’ Answer to Escalating Costs?

States increasingly are experimenting with the use of Accountable Care Organizations (ACOs) in their Medicaid programs as a possible avenue to curb the escalating costs of providing care to expanding Medicaid populations....more

CMS Announces Launch of Open Payments Database: $3.5 Billion Paid to Physicians and Teaching Hospitals

The Open Payments database (the “Database”) is now live, and the first round of data is available to the public on the Centers for Medicare and Medicaid Services (“CMS”) website. This first round of data reflects “nearly 4.4...more

Amid the Sunshine, Controversy Lingers: The Release of CMS's "Open Payments" System

In a March 2013 post on the Insider blog, we noted the issuance by the Centers for Medicare and Medicaid Services (CMS) of a long-awaited final rule mandating the collection of information regarding payments that drug and...more

Health Reform + Related Health Policy News - September 2014, Issue 1

In This Issue: - Top News ..The Congressional Agenda is Light as the Focus Shifts to the Midyear Elections ..Physician Supervision Requirement for Small and Rural Hospitals ..CMS Offers Hospitals...more

CMS Charges $13 Million Late Payment Fee on $1 Million Medicaid Overpayment

To add insult to injury, the overpayments were inadvertent—the result of electronic coding errors on about 900 Medicaid claims. On top of that, Mt. Sinai itself didn’t make the errors. They were made by two hospitals in the...more

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