Recent federally qualified health center (FQHC) litigation highlights the impact state Medicaid agencies have on FQHC reimbursement. The important decisions summarized below all involve FQHC disputes over state Medicaid...more
The California Department of Health Care Services (DHCS) funds healthcare services for more than 15.4 million Medi-Cal beneficiaries. About one-third of Californians receive health care services financed or organized by DHCS,...more
On September 1, 2023, the D.C. Circuit affirmed the D.C. District Court’s decision in Pomona Valley Hosp. Med. Ctr. v. Azar, 2020 WL 5816486, at *1 (D.D.C. Sept. 30, 2020) requiring CMS to produce affirmative evidence as to...more
Trending in Telehealth highlights state legislative and regulatory developments that impact the healthcare providers, telehealth and digital health companies, pharmacists and technology companies that deliver and facilitate...more
California’s Department of Health Care Services (DHCS) is in the final stages of establishing new Medical Loss Ratio (MLR) requirements in Medi-Cal Managed Care. Most significantly, the guidelines specify that the MLR...more
In our practices, we are seeing an increasing number of denials or de facto denials of Medi-Cal provider enrollments. The consequences of a Medi-Cal enrollment denial can be quite serious. First, a provider may not receive...more
Here are curated AG and federal regulatory news stories highlighting key areas in which state and federal regulators’ decisions are having an impact across the US: •Radio, Someone Still Loves You - •FTC Endorsement Guides...more
California AG Rob Bonta, in partnership with the DOJ, settled with four health care providers to resolve allegations that they violated state and federal False Claims Acts through the submission of fraudulent claims to...more
Background - The use of telehealth increased exponentially in 2020 and 2021 as health care providers and patients responded to the COVID-19 pandemic. The Government Accountability Office (GAO) estimated that the use of...more
In February 2023, the California Department of Health Care Services (DHCS) published the Medi-Cal for Kids & Teens Outreach and Education Toolkit. The Toolkit was developed to promote and improve understanding among families,...more
California AG Rob Bonta settled with pharmacy benefit manager (PBM) Centene Corporation and its subsidiaries in connection with alleged overcharges by Centene to California’s Medi-Cal program....more
Here are curated AG and federal regulatory news stories highlighting key areas in which state and federal regulators’ decisions are having an impact across the US: •AG James Settles over Sale of Unlawful Monitoring Software-...more
California AG Rob Bonta settled with Hey Favor, Inc. and affiliated and predecessor entities that previously conducted business as “The Pill Club” for allegedly violating the California False Claims Act by knowingly...more
The Big Picture - On January 26, 2023, the Centers for Medicare & Medicaid Services (CMS) approved California’s request to amend the California Advancing and Innovating Medi-Cal (CalAIM) Section 1115 demonstration. A...more
California’s Advancing and Innovating Medi-Cal (CalAIM) seeks to transform the Medi-Cal (California Medicaid) delivery system for more than 14 million Californians, embracing a population health approach that prioritizes...more
This is the first article in a series addressing key changes to the California health care marketplace, focused on changes to California’s behavioral health delivery systems. Forthcoming articles in the series will address...more
In this episode, Foley partner Anil Shankar discusses California’s new Medicaid wavier called CalAIM, (California Advancing and Innovating Medi-Cal, the multiyear care delivery and payment reform initiative led by the...more
The recently unveiled California Health and Human Services Data Exchange Framework (the Framework) creates a new regulatory and governance structure to promote the exchange of health information between health care providers...more
Many California health care providers, including hospitals and physician groups, will soon be required to sign on to California’s first-ever statewide data sharing agreement governing the exchange of health and social...more
The following is a summary of the federal Health and Human Services agency’s Office of Inspector General (OIG) reports of fraud and abuse enforcement activity across the country. The enforcement actions reported are based...more
As experts drill down to discover why nursing homes and other long-term care facilities are not playing a vital role in the U.S. health system by admitting improving patients from costly care in overwhelmed hospitals, a...more
We begin the year with a case, Riverside County Public Guardian v. Snukst (2022) ___ Cal.App.5th ___, involving an elder with dementia who received Medi-Cal benefits. The case, a blast from the past, illustrates how the...more
On December 29, 2021, the California Department of Health Care Services (DHCS) announced CMS’s approval of its California Advancing and Innovating Medi-Cal (CalAIM) proposal. CalAIM’s launch on January 1, 2022 is part of a...more
As the COVID-19 pandemic continues across the United States, states, payers, and providers are looking for ways to expand access to telehealth services. Telehealth is an essential tool in ensuring patients are able to access...more
Family Health Centers of San Diego (Health Center) operates a federally qualified health center (FQHC) that has 49 locations throughout San Diego County, California, and provides a comprehensive range of primary and...more