News & Analysis as of

Finally, Some Good News for Halifax–And All Other–Hospitals

It’s been a long time since Orlando’s Halifax Hospital got any good news from the federal court hearing the whistleblower case brought by employee Elin Baklid-Kunz. Earlier this year the hospital had to agree to an $85...more

Lessons From Omnicare Settlement In 'Swapping' Cases

On June 25, the U.S. Department of Justice announced that it had settled with Omnicare Inc. in two matters alleging that kickbacks resulted from below-cost discounts offered to skilled nursing homes as an inducement to select...more

Shorts on Long Term Care - Summer 2014

In this issue: - Nursing Facility Survey Trends: Directed Plans of Correction, Privacy Violations and FTag 520 Quality Assurance Committee Citations - COBRA Meets ACA – Time to Update COBRA Notices -...more

Medicare Part C Update: Co-Insurance Payments

Prior to the implementation of NC Tracks, the North Carolina Medicaid program would pay co-insurance for correctly filed claims for dual eligible residents (Medicare and Medicaid) who were covered primarily by Medicare Part C...more

Is Off-Label Drug Promotion Protected Free Speech?

It is a very common practice. Drug sales reps visit a client, usually a hospital, a clinic or a doctor, with the sole purpose of selling a drug or medical device. That is the primary way a doctor learns about a drug or...more

Health Headlines: Also in the News - July 2014 #3

CMS Revises Medicare Advantage and Part D Prescription Drug Plan Prior Authorization Requirement for Hospices – On July 18, 2014, CMS released a revised a memorandum outlining responsibility for drug payments for hospice...more

Nursing Facility Survey Trends - Directed Plans of Correction, Privacy Violations and FTag 520 Quality Assurance Committee...

Directed Plans of Correction, or DPOCs, have long been part of the arsenal of enforcement sanctions available to the Centers for Medicare & Medicaid Services for survey deficiencies, just like civil money penalties (CMPs);...more

ACOs And Pay for Value … About the Data

It has been over three years since the Centers for Medicare and Medicaid Services (CMS) announced its proposed rule and guidance on the development and implementation of Accountable Care Organizations. About four million...more

Will There Be Tax Credit Subsidies for Health Coverage Purchased on the Federal

There is no letup in the intensity of the litigation wars surrounding the Affordable Care Act (ACA) or in the significance of the matters at issue. In 2012, the Supreme Court narrowly upheld the ACA in the face of a...more

Senate Special Committee on Aging Addresses Medicare Audits

On July 9, 2014, the United States Senate Special Committee on Aging released a report titled “Improving Audits: How We Can Strengthen the Medicare Program for Future Generations.” Among other recommendations, the report...more

Health Update - July 2014

Avoiding the Regulatory Land Mines of Commercial ACOs - While providers are showing great interest in creating ACOs to participate in the Medicare Shared Savings Program (MSSP), they are showing even greater enthusiasm...more

Health Care Reform Implementation Update - July 2014

Last week the Senate debated a bill to reverse the Supreme Court’s contraception mandate decision, a group of House Republicans introduced a bill to replace Affordable Care Act (ACA) cuts to the Medicare home health benefit...more

Congress Sends Mixed Messages to Health Care Providers

Recent federal health care legislation sent mixed signals to health care providers. Pursuant to HR 4302, signed by President Obama on April 2, planned Medicare reimbursement cuts of 24 percent and the implementation of a...more

Anatomy of an Independent Primary Care ACO, Part I

While concepts and theories can go a long way, sometimes the best way to understand something is through a concrete example. So, from time to time, ACO Insider will check in on a new accountable care organization composed of...more

News from the Health Law Gurus™: July 2014

Survey of ACA Navigators Finds 10.6 Million People Sought Enrollment Help — In a survey released this week, the Kaiser Family Foundation (“Kaiser”) estimates that approximately 10.6 million people received assistance...more

D.C. Circuit Says CMS Doesn’t Know What’s New

On Tuesday of last week the D.C. Circuit Court ruled that the Provider Review Reimbursement Board doesn’t know what’s new. It reversed the PRRB’s decision, along with the District Court’s decision that upheld it. In doing...more

Medicaid Claims And Health Care Fraud: As The Data Flows, New Cracks Emerge

As we noted in two of our prior posts in the Insider blog, the government has long touted its ability to rely upon data mining as a means of detecting fraud in the federal health care system, and has initiated a host of...more

The ACA’s Bumpy Ride

From the monumental failure of the initial government website for the federal health insurance marketplace (healthcare.gov) to the looming employer mandate, the Affordable Care Act has garnered its fair share of criticism....more

New Flexibility Under the Medicare Conditions of Participation: A Single Medical Staff Option for a Multi-Hospital System and...

As described in our prior alert, the Centers for Medicare & Medicaid Services (“CMS”) has, for the past several years, been seeking ways to reduce its regulatory burden on health care providers. In furthering this initiative,...more

Medicare Patients Caught In Two-Midnight Rule Crossfire

Hospitals have been complaining about the two-midnight rule since it was first announced. But mounting evidence indicates that Medicare patients themselves are suffering badly from the effects of the rule....more

CMS Releases Proposed 2015 Physician Fee Schedule and Outpatient Prospective Payment System Rules

On July 3, 2014, the Centers for Medicare and Medicaid Services (“CMS”) released its proposed Calendar Year (“CY”) 2015 Physician Fee Schedule (“PFS”) Proposed Rule, to be published in the Federal Register on July 11, 2014....more

CMS Announces Dates for Sunshine Payment Review, Dispute & Correction Process

The Centers for Medicare & Medicaid Services (CMS) announced today that the Open Payments review, dispute and correction process will begin on Monday, July 14, 2014 and continue through September 11, 2014. ...more

OIG Report: Questionable Billing for Medicare Part B Clinical Laboratory Services

Perhaps not coincidentally, immediately following the release of the Questionable Laboratory Payments Special Fraud Alert by the OIG, posted yesterday on the Med Law Blog, the OIG has followed up with Audit Report OIG –...more

Got A Complaint About RAC Audits? Get In Line

Criticism of the RAC (recovery audit contractor) program is becoming a national pastime. Needless to say, hospitals hated the program from the very beginning. And little wonder. The program pays private contractors a...more

CMS Proposes Elimination of CME Exception to Sunshine Act Reporting

The Centers for Medicare and Medicaid Services (“CMS”) issued a proposed rule that includes a plan to eliminate the continuing medical education (“CME”) exclusion to the reporting requirements under the federal Physician...more

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