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

HHS and Medicare Asked to Expand Coverage for Genetic Tests

Fifteen members of Congress have asked the Department of Health and Human Services (HHS) and the Medicare Payment Advisory Commission (Medicare) to examine how the federal government can help improve patient access to genetic...more

Changes to Medicaid Expansion in the American Health Care Act:  State-by-State Estimates of the Coverage and Fiscal Impact

The House currently is considering the American Health Care Act (AHCA), a bill to repeal and replace the Affordable Care Act (ACA). Among other things, the bill will phase out enhanced federal funding for the expansion of...more

Escobar's Impact: Recent Application of "Materiality" in Ninth Circuit

Last year, a unanimous U.S. Supreme Court decided Universal Health Services, Inc. v. United States ex rel. Escobar (Escobar), 136 S.Ct. 1989 (2016), creating important implications for Federal False Claims Act (FCA) cases...more

Health Update - March 2017

The Future of Essential Health Benefits - Editor's Note: The Essential Health Benefits (EHB) rule may be among the many parts of the Affordable Care Act (ACA) that are on the chopping block as the Trump Administration and...more

Future of the Affordable Care Act and the American Health Care Act

This week, in their “Future of the Affordable Care Act” series on our Employment Matters blog, my colleagues Alden Bianchi and Edward Lenz provided an analysis of the major provisions of the American Health Care Act...more

Manager Amendments to the American Health Care Act

On Monday March 20, 2017, technical and policy amendments to the American Health Care Act of 2017 (AHCA) were introduced to address concerns by more conservative Republicans. The House is expected to vote on the AHCA as early...more

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

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