On October 28, the Texas Medical Association (TMA), a trade association that represents more than 55,000 physicians and medical students, filed a lawsuit in the Eastern District of Texas challenging key portions of CMS’s...more
On August 13, the D.C. Circuit revived the CMS 2014 Medicare Advantage Overpayment Rule in deciding UnitedHealthcare Ins. Co. v. Becerra, a ruling that could have broad implications for Medicare Advantage (MA) insurers. See...more
On June 23, the U.S. District Court for the District of Columbia dismissed a challenge to a federal rule requiring hospitals to disclose prices they privately negotiated with insurers....more
6/26/2020
/ Affordable Care Act ,
Arbitrary and Capricious ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Final Rules ,
First Amendment ,
Health Care Providers ,
Healthcare Reform ,
Hospitals ,
Price Transparency ,
Public Disclosure ,
Secretary of HHS ,
Service Charges
On November 15, the Centers for Medicare and Medicaid Services (CMS) issued a final rule requiring public disclosure of hospital charges. Along with the Departments of Health and Human Services, Labor and the Treasury, CMS...more
11/20/2019
/ Centers for Medicare & Medicaid Services (CMS) ,
Final Rules ,
Health Care Providers ,
Healthcare Reform ,
Hospitals ,
PHSA ,
Price Transparency ,
Proposed Rules ,
Public Disclosure ,
Regulatory Requirements ,
Rulemaking Process ,
Service Charges
On October 26, the Centers for Medicare and Medicaid Services (CMS) issued a notice of proposed rulemaking that would significantly alter the risk adjustment data validation (RADV) methodology that applies to Medicare...more
The U.S. District Court for the District of Columbia handed down a major victory to Medicare Advantage issuers on September 7, 2018, vacating a 2014 CMS regulation relating to Medicare Advantage overpayments. ...more
9/12/2018
/ Centers for Medicare & Medicaid Services (CMS) ,
False Claims Act (FCA) ,
Health Care Providers ,
Healthcare Fraud ,
Life Sciences ,
Medicare ,
Medicare Advantage ,
Overpayment ,
Overpayment Recovery Time Limits ,
Regulatory Oversight ,
Regulatory Requirements ,
Reporting Requirements
We have recently seen an uptick in state initiatives designed to skirt requirements under the Affordable Care Act (ACA). We last wrote about Idaho’s failed attempt to permit health insurers to sell noncompliant plans, which...more
Last month, we reported that Idaho announced a controversial plan to allow insurers to sell policies that do not comply with certain ACA requirements — a move that some feared would set a precedent for other states. ...more
On October 5, a federal district court in California dealt a significant setback to the government’s efforts to extend False Claims Act (FCA) liability to Medicare risk adjustment submissions....more
10/16/2017
/ Centers for Medicare & Medicaid Services (CMS) ,
Dismissals ,
False Claims Act (FCA) ,
FRCP 9(b) ,
Health Insurance ,
Healthcare Fraud ,
Materiality ,
Medicare ,
Medicare Advantage ,
Risk Adjustment Formula ,
Scienter ,
UnitedHealth ,
Whistleblowers
Often lost in the cacophony of headlines surrounding rising health care costs is the promise that value-based contracting offers as a possible solution. In contrast to the traditional fee-for-service model, value-based...more
10/6/2017
/ Alternative Payment Models (APM) ,
Anti-Kickback Statute ,
Big Data ,
Centers for Medicare & Medicaid Services (CMS) ,
False Claims Act (FCA) ,
Food and Drug Administration (FDA) ,
Medicaid ,
Medical Devices ,
Off-Label Promotion ,
OIG ,
Pharmaceutical Industry ,
Prescription Drugs ,
Regulatory Standards ,
Value-Based Payments