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United States Supreme Court Limits Deference Standard in Kisor v. Wilkie Decision

On June 26, 2019, the United States Supreme Court issued its decision in Kisor v. Wilkie. After hearing oral arguments in March, the Court considered whether to overrule the Auer deference standard, the long-standing doctrine...more

CMS Releases Proposed Rule to Update e-Prescribing Standards

On June 17, 2019, CMS released a proposed update to the transaction standard for the Medicare Prescription Drug Benefit Program’s (Part D) e-prescribing program (Proposed Rule). Specifically, the Proposed Rule would require...more

Plaintiffs Seek Leave to File Amended Complaint in Case Against Anthem for Paying Patients Directly for Rehabilitation Services

Four years after filing a complaint against Anthem Blue Cross and various employee welfare benefit plans (collectively, Defendants) for paying insurance benefits directly to insured patients instead of the Plaintiff...more

CMS Proposes National Coverage Decision For CAR-T Cancer Therapy

On February 15, 2019, CMS released a proposal to provide nationwide coverage for a new cancer therapy, Chimeric Antigen Receptor T-cell Therapy (CAR-T Therapy), for Medicare patients. The proposed nationwide coverage decision...more

CMS Releases Contract Year (CY) 2020 Medicare Advantage and Part D Flexibility Proposed Rule

On October 26, 2018, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule revising Medicare Advantage program (MA or Part C) and Prescription Drug Benefit program (Part D) regulations, implementing...more

340B Stakeholders Bring Lawsuit Against HHS Regarding Delay in 340B Regulations

A group of 340B stakeholders brought a lawsuit on September 11, 2018, against the Department of Health and Human Services (HHS) over the delay in implementing the final rule for drug pricing transparency published in the...more

District Court Grants Motion to Dismiss for Failure to State Federal Claim Under EMTALA

On July 27, 2018, the United States District Court for the District of Maine dismissed a claim that York Hospital, a Maine Hospital with a dedicated emergency room, violated EMTALA after a patient suffered a stroke and was...more

OIG Report Identifies Weaknesses in Medicaid Managed Care Organizations’ Efforts To Identify Fraud and Abuse

On July 11, 2018, OIG issued a report entitled “Weaknesses Exist in Medicaid Managed Care Organizations’ Efforts To Identify and Address Fraud and Abuse.” In its report, OIG states that Medicaid managed care organizations...more

CMS Seeking Public Comment on Stark Law Burdens

The Centers for Medicare and Medicaid Services (CMS) is seeking public comment on the burdens imposed by the Stark Law. Specifically, on June 25, 2018, CMS published in the Federal Register a Request for Information (RFI) on...more

Jury Finds Brigham and Women’s Hospital Guilty of Retaliation Against Nurse

On May 23, 2018, a jury in Suffolk County Superior Court in Boston, Massachusetts, found Brigham and Women’s Hospital guilty of retaliation and awarded $28 million to a nurse....more

CMS to Revise Coverage For Implanted Cardiac Devices

On November 20, 2017, CMS announced proposed updates to the coverage policy for Implantable Cardioverter Defibrillators (ICDs). The proposed changes would be the first major update to ICD coverage in over a decade. Over the...more

Proposed Legislation Aimed to Block 340B Drug Discount Program Cuts

On November 15, 2017, a bipartisan bill was introduced in the U.S. House of Representatives aimed at preventing CMS from reducing reimbursement by nearly 30 percent for Medicare Part B drugs purchased by certain hospitals...more

Changes to California’s Document Retention Policy

Medi-Cal and other California health care providers will soon be required to change their document retention policies and practices for services rendered under programs administered by California’s Department of Health Care...more

President Trump Signs New Executive Order To Loosen Insurance Regulations

Following multiple failed attempts by the Republican-led Congress to repeal the Affordable Care Act (ACA), on October 12, 2017, President Trump took unilateral action signing an executive order aimed at expanding choices and...more

CMS Seeks New Direction for Center for Medicare and Medicaid Innovation

On September 20, 2017, the Center for Medicare and Medicaid Innovation (“CMMI”) issued an informal Request for Information (“RFI”) seeking public feedback on “a new direction to promote patient-centered care and test...more

Appeals Court Upholds Charity Care Patient Population Exclusion from DSH Payments

On May 9, 2017, the U.S. Court of Appeals for the District of Columbia Circuit affirmed a lower court ruling denying hospitals from including New Jersey Charity Care Program (NJCCP) patients in the hospitals’ disproportionate...more

CMS Announces Solicitation for the Rural Community Hospital Demonstration Program

CMS announced solicitation for applications for participation in the Rural Community Hospital Demonstration Program (Demonstration). In this request for applications, CMS is seeking information from interested hospitals...more

U.S. District Court Rules that Hospital May Face FCA Liability Over Medical Directorship Arrangements that Lacked Written...

On March 15, 2017, the U.S. District Court for the Western District of Pennsylvania held in United States ex rel. Emanuele v. Medicor Assocs., 2017 BL 80113, W.D. Pa., No. 10-cv-245, 3/15/17, that a hospital that created...more

HHS Announces Final Rule on Medicare Benefit Claim Appeals Process

On January 17, 2017, HHS published its final rule addressing modifications to the Medicare benefit claim appeals process. The final rule seeks to reduce the significant backlog of pending Medicare appeals and streamline the...more

HHS OIG Issues Report on Medicare’s 2-Midnight Rule

On December 19, 2016, the HHS OIG issued a report on Medicare’s 2-midnight rule titled “Vulnerabilities Remain Under Medicare 2-Midnight Hospital Policy.” The report reviews data from 2013 and 2014 and reaches several...more

CMS Delays Stricter Reviews of Medicare Home Care Claims

CMS recently announced a delay in the broad implementation of a stricter review program for Medicare home care claims that launched on a demonstration basis on August 3, 2016. CMS began the demonstration program to test...more

CMS Issues Guidance on Privacy Concerns at Nursing Homes

Earlier this month, CMS issued guidance regarding privacy concerns in nursing homes. In a letter entitled “Protecting Resident Privacy and Prohibiting Mental Abuse Related to Photographs and Audio/Video Recordings by Nursing...more

CMS Considers Delaying MACRA Start Date

On July 13, 2016, CMS Acting Administrator Andy Slavitt testified before the Senate Finance Committee regarding the possibility of a delay in implementation of the Medicare Access and CHIP Reauthorization Act (MACRA). ...more

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