News & Analysis as of

Medicare Medicaid

Senate Releases Repeal and Replace Legislation on ACA: The Better Care Reconciliation Act of 2017

by Foley & Lardner LLP on

After weeks of secrecy, the Senate has released a discussion draft of legislation that is the counterpart of the American Health Care Act (AHCA) previously passed by the House. The Senate legislation, entitled the Better Care...more

Electronic Health Records Vendor Agrees to $155 Million Settlement to Resolve FCA Allegations, Required to Make Free Upgrades to...

by King & Spalding on

On May 31, 2017, the DOJ announced a $155 million settlement with eClinicalWorks (ECW), one of the nation’s largest electronic health records (EHR) vendors, to resolve a False Claims Act lawsuit brought by a whistleblower. ...more

The Better Care Reconciliation Act of 2017 vs. The American Health Care Act: Summary of Key Differences

On June 22, 2017, Senate Republicans released a discussion draft of their proposal to repeal and replace the Affordable Care Act (ACA), titled the “Better Care Reconciliation Act of 2017” (BCRA). Beyond the title change,...more

Genesis Healthcare Settlement with Federal Government

by Dorsey & Whitney LLP on

On June 16th, 2017, The Department of Justice (“DOJ”) announced a $53.6 million dollar settlement with Genesis Healthcare Inc. (“Genesis”) over six federal whistleblower lawsuits alleging that subsidiaries of the...more

Senate GOP’s Health Care Plan Reshapes House’s Bill to Repeal and Replace the Affordable Care Act

by Epstein Becker & Green on

When the House of Representatives narrowly passed H.R. 1628, the American Health Care Act (AHCA), and shipped it across the Capitol for the Senate’s consideration, key senators said they intended to write their own bill...more

Uncle Sam’s bad reverse: nursing homes returning to forced arbitration

Look out Baby Boomers and Gen Xers: Just when you or your elderly loved ones may be most vulnerable and needing nursing home care, the government is going back to allowing nursing home administrators to push a pile of...more

OIG Reports More Than $731 Million in Inappropriate Medicare Meaningful Use Payments

by McDermott Will & Emery on

The Electronic Health Records (EHR) Incentive Program run by Centers for Medicare and Medicaid Services (CMS) garnered attention again last week following the release of a report by the Office of Inspector General of the US...more

Court Puts the Brakes on Whistleblower's FCA Parking Claims

by Baker Ober Health Law on

The Department of Justice (DOJ) reports that, in fiscal year 2016 ending September 30, it obtained more than $4.7 billion in settlements and judgments from civil cases involving fraud and false claims. More than half of this...more

"Meaningfully Useful" Risk Mitigation Strategies for Providers Following the eClinicalWorks Settlement

by Jones Day on

The Health Information Technology for Economic and Clinical Health Act ("HITECH Act") established financial incentives under Medicare and Medicaid for eligible health care providers that adopt, implement, and demonstrate use...more

First Look at OIG’s FY 2017 Fraud Recoveries/Enforcement Activities

by Reed Smith on

The HHS Office of Inspector General (OIG) expects its investigative recoveries during the first half of fiscal year (FY) 2017 to top $2.04 billion – which is down from $2.77 billion for the first half of FY 2016. During this...more

OIG Targets Additional Medicare/Medicaid Policy Areas for Review

by Reed Smith on

The OIG has added 18 reviews to its FY 2017 Work Plan – most of which target CMS programs, with a particular emphasis on prescription drug policies. For instance, the OIG now intends to examine the following Medicare and...more

Privacy Tip #92 – Finally, HHS is Removing SSNs From Medicare Cards

For those of you who know me, you know that I have been very frustrated with the federal and state governments for continuing to use Social Security numbers for eligibility, enrollment and participating in Medicare and...more

Manatt on Health Reform: Weekly Highlights - June 2017 #2

CMS seeks input on potential market stabilization rulemaking; Iowa proposes a single standardized Marketplace plan and reinsurance program; and Centene will expand its Marketplace offerings for 2018, including adding new...more

CMS finalizes additional delay for episodic payment programs

by Thompson Coburn LLP on

After earlier delays following the change in administration and leadership, the Centers for Medicare and Medicaid Services (CMS) has set the start date for cardiac episode payment models (EPMs) and revisions to the...more

OIG Faults CMS for its Medicare and Medicaid Improper Payment Rates

by King & Spalding on

Under the Improper Payments Information Act of 2002, as amended, the Department of Health and Human Services (HHS) is required to annually report on improper payments and meet certain improvement metrics. In a report...more

OIG Publishes Semiannual Report to Congress

Earlier this month, the Office of the Inspector General for the Department of Health and Human Services (“OIG”) published its Semiannual Report to Congress covering the period from October 1, 2016 to March 31, 2017. The...more

Can Congress Get to “Yes” on Replacing the Affordable Care Act?

Senate Majority Leader Mitch McConnell recently gave a candid assessment of the chances of getting an Affordable Care Act (ACA) replacement bill through the Senate, saying “I don’t know how we get to 50 (votes) at the...more

False Claims Act Settlement with eClinicalWorks Raises Questions for Electronic Health Record Software Vendors

by McDermott Will & Emery on

On May 31, 2017, the US Department of Justice announced a Settlement Agreement under which eClinicalWorks, a vendor of electronic health record software, agreed to pay $155 million and enter into a five-year Corporate...more

A Striking EHR Settlement: The DOJ pursues an EHR Vendor for "Causing the Submission" of False EHR Incentive Payment Claims

by Bass, Berry & Sims PLC on

On May 31, 2017, the U.S. Department of Justice (DOJ) announced a $155 million settlement with eClinical Works (ECW), a nationally-known electronic health records (EHR) software vendor. The settlement arises out of a lawsuit,...more

CMS changes the SRDP process effective June 1, 2017

by Thompson Coburn LLP on

If you are in the process of drafting a SRDP submission, you must use the new SRDP forms or risk CMS not accepting the disclosure into the protocol. Effective June 1, 2017, the Centers for Medicare and Medicaid Services’...more

Code Red: Healthcare Restructurings on the Rise

Financial distress – sometimes it is isolated to specific borrowers and other times, it is endemic within an industry. In recent years, energy (e.g., oil, gas, and coal), retail and other industries have suffered widespread...more

President Trump’s Proposed FY 2018 Budget Spares Medicare, But Calls for Deep Medicaid Cuts & FDA User Fee Hikes

by Reed Smith on

President Trump has released his FY 2018 budget proposal, which the Administration dubs “A New Foundation for American Greatness.” The proposed budget – which received a generally chilly reception on Capitol Hill – offers a...more

New York Man Sentenced To 10 Years In Prison For Involvement In $26 Million “Billing Mill”

by Fox Rothschild LLP on

Last month, a New York man was sentenced to 10 years in prison for allegedly operating a $26 million scheme to defraud Medicare and Medicaid. The defendant allegedly established 6 medical clinics in Brooklyn that paid elderly...more

Issues for Employers as Health Care Legislation Moves to the Senate

by Jones Day on

ABSTRACT - Although the American Health Care Act, as passed by the U.S. House of Representatives, mainly affects the individual and small group health insurance markets, it has implications for large employers. The repeal of...more

New Criminal and SEC Charges Signal Aggressive Enforcement of Insider Trading Liability for Disclosure of Political Intelligence

by Ropes & Gray LLP on

On May 24, 2017, the U.S. Attorney’s Office for the Southern District of New York (“SDNY”) and the U.S. Securities and Exchange Commission (“SEC”) announced insider trading charges relating to a scheme in which a federal...more

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