Medicaid

Medicaid is a partnership program between states and the federal government to provide healthcare coverage for lower income individuals, people with disabilities, older people, and certain families with... more +
Medicaid is a partnership program between states and the federal government to provide healthcare coverage for lower income individuals, people with disabilities, older people, and certain families with children.  less -
News & Analysis as of

Percentage-Based Billing Contracts Violate Medicaid Regulations and May Constitute Improper Fee-Splitting

The Medicaid Fraud Control Unit (MCFU) of the New York State Office of the Attorney General has recently issued restitution demand letters to providers for allegedly entering into percentage-based contracts with their billing...more

Manatt on Health Reform: Weekly Highlights - March 2017 #3

House Republicans append a Manager's Amendment to the AHCA; HHS tells states they will have increased flexibility on Medicaid; and Florida previews its 1115 waiver amendment requests....more

New York Medical Society Warns Providers to Avoid Percentage-Based Billing

A series of recoupment letters from the New York State Medicaid Fraud Control Unit (MFCU) to healthcare providers who have management or billing company arrangements based on a percentage of collections has prompted the...more

OIG Issues Favorable Advisory Opinion Relating to Free Hotel Lodging and Cafeteria Meals for Qualifying Patients

On March 3, 2017, the U.S. Department of Health and Human Services, Office of Inspector General (OIG) issued Advisory Opinion 17-01. The Opinion relates to a request by an academic medical center (the “Requestor”) consisting...more

Key components of the proposed American Health Care Act [Video]

Michael Lampert, Ropes & Gray health care partner, analyzes key changes proposed by the American Health Care Act. __ In the 2012 election, we heard that the Affordable Care Act would be repealed. In the 2016 election, we...more

Excluded Party Cases Dominate OIG Published Self Disclosure Settlements

In 2013, the HHS Office of Inspector General issued revised protocols outlining the process through which health care providers are able to self-disclose and resolve potential liability under the OIG’s civil monetary penalty...more

Healthcare Reform: Where is it Heading?

While there have been several reports about the prospects of the American Health Care Act (“AHCA,” “Trumpcare” or “Ryancare,” depending on who you ask), please be mindful that in 2009-10, many people thought the Affordable...more

The American Health Care Act – A Side-by-Side Comparison to Existing Law

As reported in our January 23, 2017 Clients & Friends Memorandum entitled “Status of the Affordable Care Act Repeal Efforts,” on January 12 and 13, 2017, the Republican-controlled Congress took the first step toward repealing...more

States May See Earliest Opportunities to Alter Health Care Landscape

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

Proposals to Cap State Medicaid Funding: Massachusetts Considerations - Prepared for the Massachusetts Coalition for Coverage and...

In a new chart pack commissioned by the Blue Cross Blue Shield of Massachusetts Foundation for the Massachusetts Coalition for Coverage and Care, Manatt Health provides an overview of proposals to cap federal Medicaid funding...more

Federal Health Care Leaders Write Governors About New Direction for Medicaid

While much of the attention related to health care this week is focused on our nation’s capital, all 50 state governors have received a letter from recently confirmed U.S. Health & Human Services Secretary Tom Price and...more

Mintz Levin Health Care Qui Tam Update - Recently Unsealed Whistleblower Cases: March 2017

Trends & Analysis - ..This issue looks at 18 health care–related qui tam cases that were unsealed in whole or in part in late October through November 2016. ..The cases identified were filed in federal district courts...more

Trumpcare’s numbers don’t add up (except for the wealthy)

After seven years, many dozens of repeal votes in Congress, and with the health of hundreds of millions of Americans at stake, can it be that the GOP’s plans to repeal the Affordable Care Act will come down to numbers?...more

Mintz Levin Health Care Qui Tam Update: Recently Unsealed Whistleblower Cases

Featured Unsealed Cases United States ex rel. Thomas v. Best Choice Home Health Care Agency, Inc., No. 2:13-cv-02209 (D. Kan.) - Complaint Filed: May 6, 2013 - Complaint Unsealed: October 24, 2016...more

Trump Administration Signals More Administrative Flexibility for State Medicaid Programs, with Emphasis on “Most Vulnerable...

In her first act as CMS Administrator, Seema Verma joined HHS Secretary Tom Price in writing to the nation’s Governors to urge collaboration on improving the Medicaid program, with an emphasis on services for “truly...more

Provider Payments Under a Medicaid Per Capita Cap

In a February 24th blog post, we described Medicaid block grants and per capita caps in terms of A x B = C to demonstrate how those payment policies work. ‘A’ is the amount a state is paid per beneficiary, ‘B’ is the number...more

The Uncertain Future of the 340B Drug Discount Program

Here we are in March 2017 and no one is sure where things stand with the 340B Drug Discount Program. HRSA and its oversight of the 340B program are subject to the recent Executive Orders restricting issuance of federal...more

False Claims Act Dangers on Display in Ruckh

A recent jury verdict in an FCA lawsuit pending in the United States District Court for the Middle District of Florida resulted in a not-so-subtle reminder of just how high the stakes can be in such litigation....more

American Health Care Act in the U.S. House of Representatives

On January 13th, Congress passed the Fiscal Year 2017 Budget Resolution (S. Con. Res. 3) which included reconciliation instructions for the House Committees on Energy and Commerce and Ways and Means and the Senate Committees...more

Congressional Budget Office Releases Report on American Health Care Act

The Congressional Budget Office (CBO) released its cost estimate of the American Health Care Act (AHCA) as reported by the Committees on Ways and Means and Energy and Commerce. CBO estimates that AHCA would reduce federal...more

Trumpcare’s hit on the poor also would steal benefits from the middle-class elderly

Republicans have long fumed about the federal government’s role in health care, ever since Medicare for the elderly and Medicaid for the poor were both passed in 1965. Now, though, we’re at a crossroads, where a frontal...more

And . . . the . . . CBO . . . Scooooores!

Here are the highlights we took (quickly) from yesterday afternoon’s Congressional Budget Office Cost Estimate for the American Health Care Act. The AHCA “would reduce federal deficits by $337 billion over the 2017-2026...more

ACA Repeal: The Middle Part

Screenplays, new business ventures and major legislation typically have problems in Act II. Hopes were raised so high in Act I. Now, things seem to drag on and on, pointlessly. Friends tell you to give up or start over...more

Capitol Hill Healthcare Update

Republican leaders on Capitol Hill face growing cross pressures from different factions of GOP lawmakers over their emerging legislation to replace the Affordable Care Act (ACA). Conservatives in the House and Senate...more

New Legislation Proposes to Repeal and Replace the ACA

The U. S. House of Representatives (the House) proposed two bills to “repeal and replace Obamacare” last week, and while many popular consumer protections under the Patient Protection and Affordable Care Act (ACA) look to be...more

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