Tesch Leigh West at Morgan Lewis

Unpackaging CMS’s HOPPS Proposed Rule and Payments for Diagnostic Radiopharmaceuticals

In what can only be characterized as a necessary but significant proposed departure from current political initiatives focused on lowering pharmaceutical drug prices, the Centers for Medicare & Medicaid Services (CMS)...more

7/23/2024 / Centers for Medicare & Medicaid Services (CMS) , Drug Pricing , Medicare , Medicare Part B , Pharmaceutical Industry , Prescription Drugs

Medicare Advantage: Managed Care Compliance in 2024

The Medicare program is broken down into four parts. Part A covers the cost of healthcare items and services provided during inpatient hospital stays as well as skilled nursing facility, hospice, and some home health care....more

3/21/2024 / Centers for Medicare & Medicaid Services (CMS) , Fee-for-Service , Health Care Providers , Medicare , Medicare Advantage , Prescription Drugs

Once Again #1: Health Care Fraud Leads DOJ False Claims Act Recoveries in 2024

The US Department of Justice (DOJ) Civil Division released its annual fraud statistics on February 22, highlighted by False Claims Act (FCA) settlements and judgments exceeding $2.68 billion in fiscal year 2023. DOJ released...more

2/26/2024 / Department of Justice (DOJ) , False Claims Act (FCA) , Health Care Providers , Healthcare Fraud , Kickbacks , Medicare Advantage

US Supreme Court Hears Oral Arguments in Challenge to Chevron Deference

The US Supreme Court recently debated the future of the legal precedent known as Chevron deference in two separate cases arising out of the National Marine Fisheries Service’s statutory interpretation of the Magnuson-Stevens...more

1/26/2024 / Chevron Deference , Loper Bright Enterprises v Raimondo , Magnuson-Stevens Act (MSA) , National Marine Fisheries Service , Oral Argument , Relentless Inc v US Department of Commerce , SCOTUS

Medicaid Unwinding: CMS to Withhold Federal Medicaid Funding from Noncompliant States

Since our publication on disenrollments caused by the “unwinding” of Medicaid’s continuous enrollment condition, the Centers for Medicare and Medicaid Services (CMS) issued an interim final rule on December 6, 2023...more

12/20/2023 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Interim Final Rules (IFR) , Medicaid

Medicaid’s Unwinding: Significant Disenrollments Will Affect Plans, Providers, and Patients

Estimates show that Medicaid enrollment grew by more than 20 million (approximately 31%) during the public health emergency (PHE) and the top Medicaid managed care organizations (MCOs) experienced a 44.1% increase in managed...more

12/6/2023 / Consolidated Appropriations Act (CAA) , Department of Health and Human Services (HHS) , Families First Coronavirus Response Act (FFCRA) , Medicaid , Public Health Emergency

Don’t Wait to Review CMS’s Proposal to Implement Minimum Managed Care Appointment Wait Times

The Centers for Medicare & Medicaid Services (CMS) proposed on April 23, 2023 two rules that would affect Medicaid managed care: Ensuring Access to Medicaid Services (CMS 2442-P) and Medicaid and Children’s Health Insurance...more

6/29/2023 / Centers for Medicare & Medicaid Services (CMS) , Fee-for-Service , Health Care Providers , Managed Care Contracts , MCOs

Medicaid Changes Now and Later: What to Expect at the End of the PHE and Beyond

Medicaid enrollment grew significantly during the public health emergency (PHE). States implemented expanded eligibility and enrollment as well as reduced cost sharing and premiums based on Medicaid program regulatory...more

5/11/2023 / Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Department of Health and Human Services (HHS) , Families First Coronavirus Response Act (FFCRA) , Medicaid , Public Health Emergency , Telehealth

How the End of the PHE Will Impact the Healthcare Industry

The Biden administration announced on January 30, 2023 that the COVID-19 Public Health Emergency (PHE) would officially end on May 11, 2023. The PHE declaration, which first was issued by the Secretary of the US Department of...more

5/11/2023 / Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Emergency Use Authorization (EUA) , Food and Drug Administration (FDA) , Life Sciences , Medicare , OCR , Public Health Emergency , Telehealth

Saved by the Bell? Telehealth Remains Largely Intact When PHE Ends

Healthcare providers are scrambling to understand the impacts of the May 11 expiration of the COVID-19 public health emergency (PHE). Luckily for most telehealth providers, the outlook of their operations post-PHE is...more

5/10/2023 / Consolidated Appropriations Act (CAA) , Coronavirus/COVID-19 , Health Care Providers , OIG , Public Health Emergency , Telehealth , Telemedicine

CMS’s Final RADV Rule Announces No Extrapolation Methodology, No FFS Adjuster

The Centers for Medicare and Medicaid Services (CMS) issued a final rule on the use of extrapolation to determine overpayments in risk adjustment data validation (RADV) audits of Medicare Advantage organizations (MAOs) and...more

2/24/2023 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicare , Medicare Advantage , Medicare Advantage Organizations (MAOs)

DOJs False Claims Act 2022 Year in Review Shows Significantly Lower Recoveries in the Healthcare Industry

The US Department of Justice’s (DOJ’s) Civil Division released its annual fraud statistics on February 7, covering fiscal year 2022. Settlements and judgments under the False Claims Act (FCA) exceeded $2.2 billion in the...more

2/10/2023 / Anti-Kickback Statute , Department of Justice (DOJ) , Enforcement Actions , False Claims Act (FCA) , Health Care Providers , Healthcare Fraud , Qui Tam , Whistleblowers

CMS’s Delayed Final Rule on the FFS Adjuster Gets Delayed . . . Again

The Centers for Medicare & Medicaid Services (CMS) delayed the publication of the final rule on the use of extrapolation and the application of a fee-for-service adjuster (FFS Adjuster) in risk adjustment data validation...more

11/14/2022 / Centers for Medicare & Medicaid Services (CMS) , Fee-for-Service , Final Rules , Health Care Providers , Medicare Advantage Organizations (MAOs)

Dobbs – US Government’s Response and Its Impact on the Healthcare Industry

Following the US Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization, the federal government has issued various guidance to healthcare providers reinforcing federal legal protections or requirements...more

7/20/2022 / Abortion , Department of Health and Human Services (HHS) , Dobbs v. Jackson Women’s Health Organization , EMTALA , Healthcare Reform , OCR , Reproductive Healthcare Issues , Roe v Wade , SCOTUS

February Fast Break Recap: Risk Adjustment and Liability

Last month, we had an engaging Fast Break session covering the growing importance of risk adjustment in various health insurance programs and novel government theories of liability associated with risk adjustment reporting....more

3/16/2022 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Health Insurance , OIG

August Fast Break Recap – CMS Telehealth and RPM Updates

We hosted a very informative Fast Break session last month on CMS telehealth and RPM updates. If you weren't able to join us, the session was led by healthcare litigation associates Jake Harper and Tesch West, with special...more

9/10/2021 / Centers for Medicare & Medicaid Services (CMS) , Consolidated Appropriations Act (CAA) , Coronavirus/COVID-19 , Health Care Providers , Medicare , Physician Fee Schedule , Proposed Rules , Telehealth , Telemedicine

Tesch Leigh West

Morgan Lewis

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