News & Analysis as of

Department of Justice (DOJ) Fee-for-Service

Epstein Becker & Green

Rare DOJ Criminal Indictment Related to Medicare Advantage Risk Adjustment

Epstein Becker & Green on

In an indictment announced on October 26, 2023 in Miami, the U.S. Department of Justice, Criminal Division’s Fraud Section, working with the FBI and HHS-OIG, brought what may be only the second federal criminal charges...more

Foley & Lardner LLP

Antitrust: DOJ Scuttles ACO Guidance, Unsettles Ground under Provider Joint Contracting Models

Foley & Lardner LLP on

On Friday, February 6, 2023, the Department of Justice (DOJ) announced the withdrawal of the 2011 Statement of Antitrust Enforcement Policy Regarding Accountable Care Organizations Participating in the Medicare Shared Savings...more

Foley & Lardner LLP

Managed Care & the FCA: Are Courts Getting It Right?

Foley & Lardner LLP on

Courts are grappling with unique questions in the context of managed care programs in False Claims Act (FCA) cases. But are they getting it right? Two questions trending in courts relate to: (1) materiality under the FCA when...more

Health Care Compliance Association (HCCA)

Report on Medicare Compliance Volume 29, Number 42. News Briefs: November 2020 #2

Report on Medicare Compliance 29, no. 42 (November 23, 2020) - CMS said Nov. 16 that the Medicare fee-for-service improper payment rate dropped to 6.27% in FY 2020 from 7.25% last year, although CMS had to “modify”...more

Health Care Compliance Association (HCCA)

Report on Medicare Compliance Volume 28, Number 42. News Briefs: November 2019 #4

Report on Medicare Compliance 28, no. 42 (November 25, 2019) - In a surprising CMS memo that just surfaced, top CMS attorneys echo the sentiments of the Department of Justice about the limits of enforcement actions based...more

Perkins Coie

President Orders FTC to Report on Competition in Healthcare Markets

Perkins Coie on

On October 12, 2017, President Donald J. Trump signed an executive order designed to promote choice and competition in healthcare markets. The order was reported as a first step in the administration’s effort to undermine the...more

Pierce Atwood LLP

Patient Safety Issues Highlighted in DOJ Settlement and Health Care Industry Cybersecurity Task Force Report

Pierce Atwood LLP on

As we know, the move away from fee for service reimbursement models is not only intended to reduce costs by no longer paying providers based on the volume of services performed, but is also intended to improve the overall...more

Mintz - Health Care Viewpoints

Senate Committee Releases Report on Potential Stark Law Changes, Hearing Scheduled

On June 30, 2016, the Senate Finance Committee’s Republican staff issued a 20-page report discussing comments made by industry stakeholders after a December 2015 round-table on the future of the physician self-referral law,...more

Baker Donelson

Congress Takes Long Look at Proposed Health Insurance Mergers

Baker Donelson on

While the Department of Justice Antitrust Division is responsible for reviewing the proposed Anthem/Cigna and Aetna/Humana mergers for any potential competitive concerns, Congress jumped into the process with both feet in...more

Robinson & Cole LLP

Health Law Pulse - October 2015

Robinson & Cole LLP on

The Health Resources and Services Administration (HRSA) recently issued proposed omnibus guidance (Omnibus Guidance) interpreting various provisions of the 340B Drug Pricing Program (340B Program). The 340B Program allows...more

Burr & Forman

Antitrust Issues Facing Physicians in Medicaid and Professional Licensing

Burr & Forman on

Physicians who were practicing in the 1990s were involved in numerous attempts to organize themselves in order to be able to participate in and even financially survive the onslaught of managed care delivery systems. The new...more

Epstein Becker & Green

Federal Trade Commission and Department of Justice Hold Joint Workshop on Payment Models and Competition Within the Health Care...

Epstein Becker & Green on

On February 24-25, 2015, the Federal Trade Commission (“FTC”) and Antitrust Division of the Department of Justice (“DOJ”) co-hosted a second public workshop as part of the “Examining Health Care Competition” series to study...more

BakerHostetler

Say Ah! FTC and DOJ to Host Second Workshop on “Examining Health Care Competition”

BakerHostetler on

On February 24-25, 2015, the FTC and the U.S. Department of Justice will host their second workshop on “Examining Health Care Competition.” The workshop will take place in Washington, D.C., and will focus on recent...more

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