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
7/12/2019
/ Administrative Agencies ,
Ambiguous ,
Appeals ,
Auer Deference ,
Kisor v Wilkie ,
Reasonable Interpretations ,
Remand ,
SCOTUS ,
Stare Decisis ,
Vacated ,
Veterans' Benefits
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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 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
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
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
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 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
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
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