News & Analysis as of

Medical Reimbursement

Top 5 Ways Telehealth Will Change Under the New Federal Funding Bill

by Foley & Lardner LLP on

The telemedicine industry has been abuzz upon learning that provider-friendly legislation was included in the new federal Bipartisan Budget Act of 2018, signed into law by the President on February 9, 2018. But telehealth...more

2019 White House and HHS Budgets Released: Key Changes to Drug Pricing and Reimbursement Proposed

by Hogan Lovells on

On February 12, 2018, the White House Office of Management and Budget released an overview of the president's Fiscal Year (FY) 2019 Budget (the Budget), which makes, among many others, several proposals regarding drug pricing...more

Escobar Compels Florida District Court to Overturn $350 Million Jury Verdict Arising from Claims of Inadequate Documentation

Last month, a U.S. District Court in the Middle District of Florida overturned judgments totaling $347,864,285 returned by a jury under the federal False Claims Act (FCA) and Florida’s state equivalent against the owners and...more

Vindication! Fifth Circuit Reverses Notorious District Court Health Care Fraud Decision

by Seyfarth Shaw LLP on

Seyfarth Synopsis: In a major victory for ERISA plans and other payors, the Fifth Circuit recently overturned a district court’s notorious decision in favor of a healthcare provider and reinstated a plan administrator’s...more

2017 Round-Up: Key Decisions Affecting Connecticut Health Care Providers

by Pullman & Comley, LLC on

Connecticut state and federal courts faced a number of significant health care issues last year. We have summarized those cases that we think are particularly relevant to Connecticut hospitals, group practices and individual...more

What the Blazes is a Healthcare Reimbursement Attorney, Anyway?

by Nexsen Pruet, PLLC on

As I sit on a delayed plane attempting to fight my way back home, I have the difficult task of attempting to clarify what it is I do. When I was a kid, I never, ever, thought, “When I grow up, I want to be a Healthcare...more

OIG Reaffirms Permissibility of Certain Gainsharing Arrangements

The Department of Health and Human Services Office of the Inspector General (OIG) has issued an Advisory Opinion (Opinion) in connection with a hospital’s gainsharing arrangement (Arrangement) with a designated group of...more

CMS imposes massive cuts on 340B program; Hospital associations’ legal challenge dismissed

by Bricker & Eckler LLP on

On November 1, 2017, CMS issued a final rule that became effective January 1, 2018, under which hospitals serving a disproportionate share of low-income patients (DSH hospitals) will receive nearly 27 percent less in...more

340B Drug Pricing Program Litigation Update

In November of last year, we wrote about a preliminary injunction being sought by hospital advocacy groups attempting to stop implementation of the Trump administration’s cuts to the 340B Drug Pricing Program (“340B...more

District Court Grants Government’s Motion to Dismiss Legal Challenge to Medicare Rate Cut for 340B Discounted Drugs

by King & Spalding on

On December 29, 2017, the United States District Court for the District of Columbia granted the government’s motion to dismiss a pre-implementation challenge to CMS’s policy to cut the Medicare reimbursement rate for...more

Telehealth Opportunities Worth Watching in 2018

by Pullman & Comley, LLC on

Continued physician shortages, reduced reimbursement from government and private insurance plans and the ever-increasing health care needs of an aging population are forcing payors and providers alike to increase the...more

Massachusetts Proposed Legislation to Curb Health Care Costs by Regulating Hospital Reimbursement Rates

by Foley & Lardner LLP on

In a previous blog post, we began to dissect the new Massachusetts State Senate bill, “An Act Furthering Health Empowerment and Affordability by Leveraging Transformative Health Care,” and focused on a provision that would...more

Connecticut District Court Provides Interpretation of ACA Provision - Decision Allows Insurers to Circumvent Hospitals in...

by Holland & Knight LLP on

• The ACA does not prevent insurers from declining to directly reimburse out-of-network hospitals for emergency care, and instead adjudicate and administer claims directly with individual patients, the U.S. District Court for...more

The 340B Drug Pricing Program: New CMS Final Rule Draws a Motion for Preliminary Injunction from Hospital Groups

On November 13, 2017, the Centers for Medicare & Medicaid Services (CMS) issued the final rule, “Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting...more

K&L Gates Triage: 340B Update: CMS Finalizes 340B Program Reimbursement Cut on Part B Drugs

by K&L Gates LLP on

In this episode, Richard Church and Ryan Severson discuss the recent decision by the Centers for Medicare and Medicaid Services (CMS) to substantially decrease reimbursement under the Outpatient Prospective Payment System...more

Newly-Announced 340B Payment Rule Presents Financial & Operational Challenges to All Covered Entities

by Polsinelli on

In its 2018 Outpatient Prospective Payment System final rule (Final Rule) issued Nov. 1, Centers for Medicare and Medicaid Services (CMS) implemented a significant Medicare Part B payment reduction for separately payable,...more

Managing the Interplay Between the ADA, FMLA and WC

by Foley & Lardner LLP on

The following description may seem quite familiar to those who deal with employee issues on a daily basis. Your employee, who has a physically demanding job on the factory floor, has been out on leave for an injury that he...more

Expanding Association Health Plans—Which Agencies Need to do What

On October 13th, President Trump signed an Executive Order directing various federal agencies to consider how to achieve three administration health reform objectives: (1) expand access to Association Health Plans (AHPs); (2)...more

Recent Merger Reflects Enhanced Need for Revenue Cycle Management Platforms

Two of the nation’s most noteworthy companies in the Revenue Cycle Management (“RCM”) technology space, Navicure Inc., and ZirMed Inc., announced a merger on September 14, 2017....more

“A Strong Pull on the Threads Holding Obamacare Together:” President Trump’s October 12, 2017 Affordable Care Act Executive Order

by LeClairRyan on

President Trump’s Executive Order titled “Promoting Healthcare Choice and Competition Across the United States” seeks to reform certain aspects of the Affordable Care Act (“ACA” or “Obamacare”) by Executive Agency action...more

The Way Forward for Telemedicine

by McDermott Will & Emery on

A lot of us have argued that one of the floodgates for telemedicine has been reimbursement. If states and the Federal government more liberally reimbursed or required reimbursement for telemedicine service, we argue then a...more

Court Finds Provider Failed to Exhaust Administrative Remedies in Suit Against Government Contractor for Withheld Reimbursement

by King & Spalding on

On August 28, 2017, the United States District Court for the Eastern District of Michigan held that a provider must fully exhaust administrative remedies before it can seek a remedy in Federal court against a Medicare...more

CMS Limits Required Participation in Comprehensive Care for Joint Replacement Model; Cancels Episode Payment Models

On August 15, 2017, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule that would significantly roll back two of CMS’s mandatory alternative payment models. The Proposed Rule would make continued...more

San Antonio Businessman Sentenced To Four Years in Prison for Defrauding Personal Injury Clients, the Bankruptcy court, and the...

by Moskowitz LLP on

From 2009 through 2014, Elpidio Gongora (aka “Pete Gongora”), operated a number of personal injury law offices in Texas, Arkansas and New Mexico. The lawyers in these firms apparently obtained settlements on behalf of their...more

Beware of TennCare Reimbursement and Prescribing Issues - TennCare Completes Implementation of the ACA's Medicaid Registration...

Due to recent TennCare changes, health care providers not registered with TennCare should consider registering to avoid issues in prescribing for TennCare patients and to preserve TennCare revenue. ...more

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