News & Analysis as of

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 -

SDNY District Court Judge Rules Escobar FCA Test Is Mandatory

by King & Spalding on

District courts nationwide have been split on the issue of whether the two-part falsity test set forth in the U.S. Supreme Court’s opinion in Universal Health Services v. Escobar must always be satisfied in federal False...more

Your Daily Dose of Financial News

by Robins Kaplan LLP on

Mylan will pay $465 million to federal authorities to resolve claims that it overcharged the Medicaid program by millions for its EpiPen products. Though large, the figure represents about a third of the estimated...more

Massachusetts Employers Face $200 Million Increase in Health Care Costs under MassHealth Amendments

On August 1, Massachusetts Governor Charlie Baker signed into law H. 3822, “An Act Further Regulating Employer Contributions to Health Care” (the “Act”). The purpose of the Act is to shore up the finances of the...more

Recess Update on the Affordable Care Act and Its Repeal and Replacement

by Ballard Spahr LLP on

The momentary lull in congressional activity on health care provides an opportune time for an update on the efforts to repeal and replace the Affordable Care Act (ACA)....more

Federal Government to Target False EHR Incentive Payments

by Barley Snyder on

While health care reform remains bogged down, the federal government’s efforts to curtail fraud, waste and abuse in its health care programs fervently continues. Most recently, the U.S. Department of Health and Human...more

State Official Charged With Taking Bribes In Connection With $1 Billion Healthcare Fraud Scheme

by Arnall Golden Gregory LLP on

On July 22, 2016, the Department of Justice announced the indictment of the owner of more than 30 Miami-area skilled nursing and assisted living facilities, a hospital administrator, and a physician’s assistant in connection...more

California Hospitals Successfully Beat Back Medicaid Payment Cut

by King & Spalding on

Almost a decade ago, California submitted a State plan amendment (SPA) to the Centers for Medicare and Medicaid Services (CMS) that would retroactively implement a ten-percent rate reduction in outpatient services provided to...more

Ninth Circuit Raises Bar for Approving Changes in State Medicaid Reimbursement

by Perkins Coie on

The U.S. Court of Appeals for the Ninth Circuit Court raised the bar last week for what states must prove to establish that their Medicaid provider reimbursement rates are sufficient to ensure a robust network of providers...more

New Jersey’s Telemedicine Law: What Providers Need to Know

by Foley & Lardner LLP on

New Jersey has a new telemedicine law, recently signed by Governor Chris Christie. The law cements the validity of telehealth services in the Garden State, establishes telemedicine practice standards, and imposes telehealth...more

Massachusetts Temporarily Imposes Employer Assessments for the Commonwealth’s Medicaid Program

by Seyfarth Shaw LLP on

Seyfarth Synopsis: On August 1, Massachusetts Governor Charlie Baker signed into law a measure intended to help the state pay for the costs of the Commonwealth’s Medicaid program, referred to as MassHealth, which covers...more

The State AG Report Weekly Update

by Cozen O'Connor on

Breaking News- Arkansas Attorney General Is New Chairman of Republican Attorneys General Association- Earlier today, the Republican Attorneys General Association (“RAGA”) named Arkansas AG Leslie Rutledge as its new...more

CMS Issues IPPS and LTCH PPS Final Rule for FY 2018

by King & Spalding on

On August 2, 2017, CMS issued the Fiscal Year (FY) 2018 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long Term Acute Care Hospital (LTCH) Prospective Payment System Final Rule (Final Rule) that updates...more

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

by Mintz Levin on

In this issue we report on recent qui tam activity and look at three unsealed cases. One case involves allegations of “up coding” by a hospital that allegedly billed routine transport as emergency transport, reimbursed at...more

CMS’s 340B Proposal Is Likely Unlawful—Here’s Why

by Morgan Lewis on

The agency’s recent proposal to reduce certain drug reimbursement is unprecedented and not based on a reasonable interpretation of its statutory authority....more

Healthcare Legislation Outlook and Update

by Holland & Knight LLP on

Below is a summary of recent U.S. Senate action on healthcare legislation and our outlook regarding coming issues and possible actions. Holland & Knight's Healthcare & Life Sciences Team will follow up as developments...more

Issues and Analysis of the State’s Medicaid Managed Assistance ITN

The recently released Invitations to Negotiate (ITN) for Florida’s Statewide Medicaid Managed Care program (SMMC) parallels in large part the State’s initial procurements that were released in 2012 and 2013. Where the current...more

Largest Health Care Enforcement Action in Department of Justice History

On July 13, 2017, the Department of Justice, in conjunction with the Department of Health and Human Services, announced the largest series of health care charges in American history. The government charged 412 individuals,...more

Baker Administration and Legislature Debate Range of Health Care Proposals

Massachusetts policymakers are currently engaged in a robust debate over several proposals aimed at lowering health care costs in the Commonwealth. The House of Representatives rejected a set of MassHealth reforms that the...more

Post-Repeal and Replace: What’s a Sponsor to Do?

by Epstein Becker & Green on

In the wake of the demise of recent Affordable Care Act “repeal and replace” efforts, both “skinny” and full boat, health care financial sponsors may wonder how they should be thinking about opportunities and threats related...more

After GOP fails to repeal Obamacare, what’s next for U.S. health care?

As the late, sultry diva Peggy Lee used to croon: Is that all there is? The Republicans in Washington, after seven years of trying and dozens of faux earlier votes, have failed to repeal and replace the Affordable Care...more

CMS Proposes Methodology to Implement Statutory Medicaid DSH Reductions

by Reed Smith on

CMS has issued a proposed rule establishing a methodology to reduce state Medicaid disproportionate share hospital (DSH) allotments annually beginning with fiscal year (FY) 2018, as mandated by the Affordable Care Act (and...more

BCRA Medicaid Provisions: Analysis of Impact on New York

In a new analysis prepared for the Coalition of New York State Public Health Plans (PHP Coalition), Manatt Health projects that if the current healthcare bill in the U.S. Senate—the Better Care Reconciliation Act (BCRA)—is...more

The State AG Report Weekly Update

by Cozen O'Connor on

2018 AG Elections- Republican Sam McClure Announces Bid for Alabama Attorney General - Sam McClure, a Birmingham adoption lawyer, announced his candidacy to become the Alabama AG. McClure is the fourth Republican to...more

When (and How) the Roll Is Called Up Yonder (Part I)

by Balch & Bingham LLP on

Senate floor activity has made this the ACA’s biggest news week not involving Justice Roberts, but whatever news you have read, rest assured that it wasn’t really that simple. Let us preach on it. Shortly after noon EDT...more

ALERT: HHA's Should Make Use of Delay in New Medicare Rules

by Pullman & Comley, LLC on

Now that the Centers for Medicare & Medicaid Services (CMS) have published a Final Rule delaying the effective date of the revised Medicare Conditions of Participation (CoP) for home health agencies (HHAs) until January 13,...more

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