News & Analysis as of

Hospitals Medical Reimbursement

Arnall Golden Gregory LLP

Healthcare Authority Newsletter - September 2024 #2

News Briefs - Licensure Compact Aims to Allow PAs to Practice in Other States - By 2028, the nation as a whole will be short some 100,000 critical health care workers, according to a new report....more

Arnall Golden Gregory LLP

Healthcare Authority Newsletter - March 2024 #4

News Briefs - Lawmaker Introduces Health Care Cybersecurity Improvement Act - Senator Mark Warner (D-VA) has introduced the Health Care Cybersecurity Improvement Act of 2024, which would allow for advance and accelerated...more

McDermott+

Policy Update - CMS Finalizes Remedy for 340B-Acquired Drugs Purchased in CYs 2018–2022

McDermott+ on

On November 2, 2023, the Centers for Medicare and Medicaid Services (CMS) finalized the rule Medicare Program; Hospital Outpatient Prospective Payment System: Remedy for the Calendar Years 2018–2022 to addresses how the...more

Robinson+Cole Health Law Diagnosis

Connecticut Governor Signs Legislation Implementing New Requirements for Hospitals and Nursing Home Facilities

Connecticut Governor Ned Lamont recently signed two important pieces of legislation that affect hospitals and certain Medicaid providers and programs. First, Public Act No. 23-39, “An Act Requiring Discharge Standards...more

Quarles & Brady LLP

CMS Proposal to Make One-Time $9 Billion Lump Sum Payment to 340B-Covered Entity Hospitals

Quarles & Brady LLP on

The Centers for Medicare & Medicaid Services ("CMS") recently announced its proposal to make a one-time lump sum payment of roughly $9 billion to 340B-covered entity hospitals that were impacted by the agency's unlawful...more

Bass, Berry & Sims PLC

Seventh Circuit Signals Ongoing Importance of Compliance with Medicare “Bad Debt” Regulations

Bass, Berry & Sims PLC on

In a recent decision, U.S. ex rel. Sibley v. Univ. of Chicago Medical Center, the U.S. Court of Appeals for the Seventh Circuit considered allegations that two medical billing and debt collection companies, Medical Business...more

Polsinelli

SCOTUS Sides with 340B Hospitals and Denies CMS’s Attempt to Cut Reimbursement for 340B Drugs

Polsinelli on

Wednesday, the United States Supreme Court handed down a highly anticipated, unanimous opinion, AHA v. Becerra, confirming that CMS exceeded its statutory authority when it implemented a discriminatory reimbursement structure...more

Robinson+Cole Health Law Diagnosis

Supreme Court Decides in Favor of 340B Hospitals Regarding Medicare Reimbursement Methodology

On June 15, 2022, the U.S. Supreme Court unanimously ruled in favor of “340B” hospitals in a notable statutory interpretation case concerning how the federal Medicare program reimburses hospitals for prescription drugs. The...more

Bricker Graydon LLP

CMS to begin reprocessing hospital claims for 2019 clinic visits provided at excepted off-campus provider-based departments

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Buried within the latest issue of the Centers for Medicare and Medicaid Services’ (CMS) MLN Connects, dated January 14, 2021, is an announcement from the agency that hospitals with excepted hospital outpatient departments...more

Benesch

Dialysis & Nephrology Digest - November 2020

Benesch on

Circuit Court revives DaVita claim that Ohio health plan violated MSPA discrimination provision - DaVita and DVA Renal Health sued the Marietta Memorial Hospital, its employee health plan and Medical Benefits Mutual Life...more

K&L Gates LLP

340B Update: Appellate Court Upholds 340B Payment Reduction as CMS Proposes Further Reductions for 2021

K&L Gates LLP on

In this week’s episode, Darlene Davis, Andrew Ruskin, and Gabriel Scott discuss notable recent developments for reimbursement under the Hospital Outpatient Prospective Payment System (“OPPS”) of drugs purchased under the 340B...more

Downs Rachlin Martin PLLC

Recovery of Medical Bills: “Face Amount” VS “Amount Paid" - Medical malpractice plaintiff may not recover more than the defendant...

For years a battle has been raging in the United States over whether a personal injury plaintiff can recover from the tortfeasor, by way of medical specials, (1) the “face amount” of her medical bills for accident-related...more

Snell & Wilmer

The Supreme Court of Arizona Holds That Hospitals May Not Use Liens Against Third-Party Tortfeasors to Balance Bill Medicaid...

Snell & Wilmer on

On March 9, 2020, the Supreme Court of Arizona issued its ruling in Ansley, et al. v. Banner Health Network, et al., 2020 WL 1126300 (2020), finding that hospitals may not utilize Arizona Revised Statutes § § 33-931(A) and...more

Robinson+Cole Health Law Diagnosis

CMS to Repay Hospitals Millions After Court Finds Reduction in Rates Improper

On December 12, 2019, the Centers for Medicare and Medicaid Services (CMS) announced that it will automatically reprocess claims which had been reimbursed at a reduced rate in 2019 under the site-neutral payment policy and...more

Katten Muchin Rosenman LLP

Health Care Law Perspectives - November 2019 • Volume I

CMS’ 340B Rate Cut Continues to Dampen Hospital Outpatient Expansion Efforts - Hospitals hoping to benefit from favorable 340B drug pricing when acquiring independent physician practices for conversion to hospital...more

Mintz - Health Care Viewpoints

CMS Ignores the Courts: 2020 Hospital Outpatient Prospective Payment System Final Rule Includes 340B Rate Cuts Already Ruled...

The Centers for Medicare and Medicaid Services (CMS) recently published the 2020 Hospital Outpatient Prospective Payment System (OPPS) rule, which finalizes a proposed reduction in Medicare Part B reimbursement for certain...more

King & Spalding

Proposed California Surprise Billing Legislation: Impacts On Access To Care And Other Lessons Learned

King & Spalding on

This article discussed legislation that was until recently pending in California (AB 1611) and that was intended to prevent patients from receiving “surprise” bills from out of network hospitals after the patients receive...more

Bricker Graydon LLP

Could relief from the Medicare cuts in reimbursement for 340B drugs be coming soon for hospitals? (UPDATE)

Bricker Graydon LLP on

Update: Following the court’s decision in May 2019, both the plaintiff hospitals and HHS filed further motions in the case – the plaintiffs moved for a firm date by which HHS must propose a remedy to the court. HHS moved for...more

Manatt, Phelps & Phillips, LLP

Court Again Rejects Medicare Part B Cuts for 340B Drugs

On May 5, a federal district court judge ruled in favor of the hospital industry plaintiffs that sued the Department of Health and Human Services (HHS) for including in the 2019 Hospital Outpatient Prospective Payment System...more

Polsinelli

Health Care Reform, Colorado-Style: What to Expect When You’re Expecting (Legislation)

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March 4, 2019 was the mid-point of the 120 day regular session of Colorado’s General Assembly. Before adjournment on May 3, 2019, significant legislative actions and resulting changes in the regulatory framework seem likely...more

Bricker Graydon LLP

Proposed California drug pricing program could shift 340B drug reimbursement away from hospitals

Bricker Graydon LLP on

On January 8, 2019, California Governor Gavin Newsom issued an executive order requiring all state agencies to consolidate into a single drug purchasing entity that will negotiate with pharmaceutical companies together....more

Sheppard Mullin Richter & Hampton LLP

340B Drug Pricing Program Litigation Update: Court Rejects CMS Drug Pricing Cuts

On December 27, 2018, the U.S. District Court for the District of Columbia issued an opinion that ruled against the Trump Administration in its plan to cut funding from the 340B Drug Pricing Program (“340B Program”). ...more

Bricker Graydon LLP

Federal court overturns 340B Drug Discount Program reimbursement cuts – future still uncertain

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On December 27, 2018, the District Court for the District of Columbia issued a decision in American Hospital Association, et al. v. Azar, No.18-2084(RC) (D.D.C. December 27, 2018), holding that the cuts imposed by the...more

Polsinelli

Federal Judge Overturns Part B Payment Cuts to the 340B Drug Discount Program

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A federal district court granted a permanent injunction against the Medicare Part B 2018 Outpatient Prospective Payment System (“OPPS”) payment cuts for separately payable, non-pass through drugs purchased through the 340B...more

Bass, Berry & Sims PLC

FCA Medical Necessity Cases May Stand on Firmer Footing After Recent Appellate Decisions

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In recent years, healthcare providers have increasingly faced civil and criminal enforcement actions premised on the allegation that services billed to government healthcare programs were not medically necessary. As a result,...more

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