Alissa Smith on Medicaid

Federal Grant and Loan “Temporary Pause” to Have a Significant Impact on the Health Care Industry

A memorandum from the Office of Management and Budget (“OMB”) on January 27, 2025 notified heads of federal agencies of a temporary pause on all disbursements of federal grants and loans, effective at 5pm Eastern on January...more

1/29/2025 / Department of Health and Human Services (HHS) , Executive Orders , Federal Funding , Grants , Health Care Providers , Hospitals , Loans , Medicaid , OMB , Trump Administration

U.S. Supreme Court Lifts Injunction Against CMS’ Health Care Facility Vaccine Mandate: What Does This Mean for Your Health Care...

Health care employers are not alone in feeling overwhelmed by the constantly changing legal status of the various federal vaccine mandates. On Thursday afternoon, the Supreme Court made its rulings on two preliminary...more

1/18/2022 / Biden Administration , Biden v Missouri , Centers for Medicare & Medicaid Services (CMS) , Constitutional Challenges , Coronavirus/COVID-19 , Employer Mandates , Health Care Providers , Healthcare Facilities , Interim Final Rules (IFR) , Medicaid , Medicare , National Federation of Independent Business v Department of Labor and OSHA , OSHA , SCOTUS , Stays , Vaccinations , Virus Testing

CMS’ COVID-19 Vaccine Mandate: What Health Care Providers Need to Know

Last week, the Centers for Medicare and Medicaid Services (CMS) and the Occupational Safety and Health Administration (OSHA) published their much-anticipated rules mandating COVID-19 vaccinations. ...more

Regulatory Sprint to Coordinated Care

In 2018, the U.S. Department of Health and Human Services (“HHS”) launched what it calls a “Regulatory Sprint to Coordinated Care” to accelerate a transformation of the healthcare system, with a focus on removing “unnecessary...more

11/23/2020 / Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Health Care Providers , Healthcare , Hospitals , Medicaid , Medicare , Physicians

The “Regulatory Sprint to Coordinated Care”

In 2018, the Department of Health and Human Services (the “Department”) launched what it calls a “Regulatory Sprint to Coordinated Care” to accelerate a transformation of the health care system, with a focus on removing...more

10/28/2019 / Anti-Kickback Statute , Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Health Care Providers , Medicaid , OIG , SAMHSA , Stark Law , Substance Abuse

Proposed Drug Rebate and PBM Service Fee Regulations Abandoned by Administration

As reported here in February, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) released two new significant proposed regulations that would have had a transformative effect on the drug...more

9/10/2019 / Anti-Kickback Statute , Department of Health and Human Services (HHS) , Managed Care Contracts , Medicaid , Medicare , Medicare Part D , OIG , Pharmacy Benefit Manager (PBM) , Prescription Drugs , Proposed Regulation , Safe Harbors

Court Invalidates Final Rule Requiring Advertisements to List Drug Prices Finding that CMS Exceeded Its Statutory Authority

In a much anticipated decision, a federal judge ruled this week that the Trump Administration’s rule requiring drug manufacturers to list drug prices in television advertisements exceeds the agency’s authority. Back in May...more

7/10/2019 / Advertising , Department of Health and Human Services (HHS) , Drug Pricing , Final Rules , Lack of Authority , Medicaid , Medicare , Pharmaceutical Industry , Prescription Drugs , Public Health , Rulemaking Process , Social Security Act , Trump Administration

CMS’s New “Primary Cares Initiative” Places Primary Care at the Center of the Shift to Value-Based Care

On April 22, 2019, the Centers for Medicare and Medicaid Services (CMS) announced two sweeping new payment innovation models under the Primary Cares Initiatives. The models will seek to incentivize primary care and other...more

4/26/2019 / ACOs , Alternative Payment Models (APM) , Cardiac Episode Payment Program , Centers for Medicare & Medicaid Services (CMS) , CMMI , Episode Payment Models (EPM) , Fee-for-Service , Health Care Providers , Medicaid , Medicare , Physicians , Request For Information , Value-Based Care

Applying Escobar’s Materiality Standard, Florida Federal Court Reverses $350 Million False Claims Act Verdict against a Nursing...

If the government does not take action and continues to pay for Medicare/Medicaid claims after it learns of non-compliance related to the claims, is the non-compliance material to the government’s decision to pay? This is a...more

1/24/2018 / Conditions of Payment , False Claims Act (FCA) , False Implied Certification Theory , Federal Contractors , Health Care Providers , Implied Certification , Materiality , Medicaid , Medicare , SCOTUS , Universal Health Services Inc v United States ex rel Escobar

6/30/2016 / Conditions of Payment , False Claims Act (FCA) , False Implied Certification Theory , Federal Contractors , Health Care Providers , Implied Certification , Material Misrepresentation , Materiality , Medicaid , Qui Tam , SCOTUS , Universal Health Services Inc v United States ex rel Escobar , Unlicensed Medical Providers

Alissa Smith

Dorsey & Whitney LLP

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