Bridgette Keller

Bridgette Keller

Mintz

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HHS Announces a “Settlement Express” Option for Medicare Appeals

HHS’s Office of Medicare Hearings and Appeals (OMHA) has long faced a backlog in Medicare appeals to Administrative Law Judges (ALJs). In an effort to address this backlog, OMHA established a Settlement Conference...more

5/31/2018  /  Administrative Backlogs , Administrative Law Judge (ALJ) , Appeals , Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Dispute Resolution , Healthcare , Medicare , OMHA , Settlement Agreements , Settlement Conferences

CMS Continues to Focus Medicare Plans on Preventing Opioid Abuse

As we highlighted earlier this month, CMS released both the Contract Year 2019 Final Rules for Medicare Advantage and Part D (Final Rules) and the 2019 Call Letter. These documents are not typically released at the same time,...more

4/23/2018  /  Call Letter , Centers for Medicare & Medicaid Services (CMS) , Comprehensive Addiction and Recovery Act of 2016 (CARA) , Drug & Alcohol Abuse , Final Rules , Health Care Providers , Medicare Part D , Opioid , Point of Sale Terminals , Prescription Drugs

CMS’s Advance Notice and Call Letter: How Medicare Plans Can Report, Identify, and Address the Opioid Epidemic

CMS has slowly but surely been providing additional guidance to Medicare Plans (Medicare Advantage and Part D plans) regarding steps they can and should take to address the opioid epidemic as it relates to their...more

3/5/2018  /  Advance Notice , Call Letter , Centers for Medicare & Medicaid Services (CMS) , Healthcare , Medicare , Medicare Advantage , Medicare Part D , New Guidance , Opioid , Pharmaceutical Industry , Pharmacies , Prescription Drugs

Proposed Medicare Advantage and Part D Regulations for CY 2019 – CMS Takes on the Opioid Epidemic

Americans today are facing an opioid epidemic that stems in part from the misuse of prescription drugs. CMS takes aim at this crisis in its CY 2019 Medicare Advantage and Part D Proposed Rule (Proposed Rules) by setting out a...more

12/6/2017  /  Centers for Medicare & Medicaid Services (CMS) , Comment Period , Comprehensive Addiction and Recovery Act of 2016 (CARA) , Drug & Alcohol Abuse , Medicare Advantage , Medicare Part D , Opioid , Pharmaceutical Industry , Prescription Drugs , Proposed Rules

Future of the Affordable Care Act and the American Health Care Act

This week, in their “Future of the Affordable Care Act” series on our Employment Matters blog, my colleagues Alden Bianchi and Edward Lenz provided an analysis of the major provisions of the American Health Care Act...more

3/24/2017  /  Affordable Care Act , Medicaid , Proposed Legislation , Repeal , Trump Administration

Mintz Levin Health Care Qui Tam Update - Recently Unsealed Whistleblower Cases: March 2017

Trends & Analysis - ..This issue looks at 18 health care–related qui tam cases that were unsealed in whole or in part in late October through November 2016. ..The cases identified were filed in federal district courts...more

3/20/2017  /  Anti-Kickback Statute , False Claims Act (FCA) , Medicaid , Medicare , Personal Care Assistants , Qui Tam , Traumatic Brain Injuries

Mintz Levin Health Care Qui Tam Update: Recently Unsealed Whistleblower Cases

Featured Unsealed Cases United States ex rel. Thomas v. Best Choice Home Health Care Agency, Inc., No. 2:13-cv-02209 (D. Kan.) - Complaint Filed: May 6, 2013 - Complaint Unsealed: October 24, 2016...more

3/17/2017  /  Anti-Retaliation Provisions , Civil Penalty Fund , Co-Conspirators , Corporate Integrity Agreement , Criminal Penalties , Dismissals , False Billing , False Claims Act (FCA) , False-Certification of Conformance , Former Employee , Guilty Pleas , Home Health Care , Intervenors , Kickbacks , Medicaid , Medicare , Qui Tam , Relators , Stark Law , State False Claims Acts , Whistleblowers

Making the Sausage: Medicaid Block Grants in the 115th Congress

Republicans have been talking about remodeling the Medicaid program through block grants or per capita caps for years. Both block grants and per capita caps are designed to limit federal spending by providing a state with a...more

11/28/2016  /  Community Development Block Grants , Department of Health and Human Services (HHS) , Healthcare Reform , Medicaid

Teladoc Receives Support from the Feds

Earlier this week, the U.S. Department of Justice (“DOJ”) and the Federal Trade Commission (“FTC”) filed an amicus brief with the Fifth Circuit stating that the Texas Medical Board’s (the “Board”) appeal was inappropriate and...more

9/16/2016  /  Amicus Briefs , Appeals , Department of Justice (DOJ) , Federal Trade Commission (FTC) , Jurisdiction , State Medical Board

Texas Medical Board’s Appeal Must Proceed Under Existing Jurisdiction Arguments

In another procedural defeat for the Texas Medical Board (the “Board”) over its embattled telemedicine rule, last week, a federal judge held that the Board waited too long to request certification of appeal to the Fifth...more

8/22/2016  /  Appeals , Commerce Clause , Proposed Rules , Sherman Act , State Action Immunity , State Medical Board , Statute of Limitations , Telemedicine

New Materials Help Covered Entities Comply with Nondiscrimination Rules

Last week, the Department of Health and Human Services (“HHS”) released new materials for covered entities to use to comply with Section 1557, the nondiscrimination provision of the Affordable Care Act. Section 1557...more

7/25/2016  /  Affordable Care Act , Covered Entities , Department of Health and Human Services (HHS) , Grievance Process , Non-Discrimination Rules , OCR , Section 1557

New Rules for ACOs in the MSSP

CMS issued a final rule, published in the Federal Register on Friday, June 10, 2016, updating how the performance of ACOs participating in the Medicare Shared Savings Program (MSSP) is measured and compensated. This rule is...more

6/16/2016  /  ACOs , Benchmarking , Centers for Medicare & Medicaid Services (CMS) , Final Rules , Medicare , Medicare Shared Savings Program

Massachusetts Establishes Road-Map for New ACO Program

Massachusetts Secretary of Health and Human Services, Marylou Sudders, held a public meeting earlier this week to receive feedback on the proposal of the Executive Office of Health and Human Services (EOHHS) to overhaul the...more

4/22/2016  /  ACOs , Department of Health and Human Services (HHS) , State Medicaid Programs

Delay in Final Rule Implementing PAMA: Sunshine Act Revisited?

As reported in our 2015 Laboratory Industry Year in Review post, the laboratory industry began 2016 amid confusion regarding how to comply with the Protecting Access to Medicare Act of 2014 (PAMA), which made the most...more

3/31/2016  /  Centers for Medicare & Medicaid Services (CMS) , Clinical Laboratory Testing , Final Rules , PAMA , Sunshine Act

CMS Releases 2017 Advance Notice and Draft Call Letter

Last week, the Centers for Medicare & Medicaid Services (CMS) released its 2017 Advance Rate Notice and draft Call Letter (“2017 Draft Call Letter”) for the Medicare Advantage (“MA”) and Part D programs. With the final 2017...more

3/1/2016  /  Centers for Medicare & Medicaid Services (CMS) , Employer Group Health Plans , Medicare Advantage , Medicare Part D , Prescription Drugs , Star Ratings , Substance Abuse , Waivers

Groundbreaking Multi-Payer Alignment on Core Measures for Quality-Based Payments

For too long, health industry stakeholders have bandied about massive amounts of information that could not be used in a comparative sense. Both public and private payers had their own proprietary reporting metrics,...more

2/24/2016  /  Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Health Care Providers , Medicaid , Proprietary Information , Provider Payments , Quality of Care Standards

The Managed Care Industry – 2015 Year in Review

As we start a new year, let’s take a look back at a few hot topics that emerged in the managed care industry in 2015 and will likely be drivers of developments in 2016. Industry Consolidation – The Changing Landscape...more

1/6/2016  /  ACOs , Affordable Care Act , Healthcare , Hospital Mergers , Managed Care Contracts , MCOs , Medicare Part D , Provider Payments , Shared Savings Program

HHS Drug Pricing Forum Highlighted in ML Strategies’ Health Care Update

This week’s ML Strategies Health Care Update highlights the recent Department of Health and Human Services (HHS) forum on prescription drug costs, which featured players from every corner of the industry, including top...more

11/25/2015  /  Competition , Congressional Investigations & Hearings , Department of Health and Human Services (HHS) , Drug Pricing , Prescription Drugs , Transparency

Government Finalizes Religious Accommodation, But What About Health Plans, TPAs and PBMs?

In a set of rules published last week, the government finalized a July 2010 interim final rule (“IFR”) related to coverage of certain preventive services and an August 2014 IFR regarding the definition of an eligible...more

7/21/2015  /  Affordable Care Act , Burwell v Hobby Lobby , Closely Held Businesses , Contraceptive Coverage Mandate , Contraceptives , Department of Health and Human Services (HHS) , Department of Labor (DOL) , EBSA , Employer Group Health Plans , Exceptions , Health Insurance , Injunctions , IOM , IRS , Non-Grandfathered Health Plans , Over The Counter Derivatives (OTC) , Pharmacies , Religious Accommodation , TPAs

HRSA Takes its First Steps on 340B Rules

The 340B Drug Discount Program has operated for more than 20 years with just a few governing regulations codified in 42 CFR Part 10. Through the Affordable Care Act (“ACA”), Congress adopted several amendments to the 340B...more

6/23/2015  /  Centers for Medicare & Medicaid Services (CMS) , Civil Monetary Penalty , Drug Pricing , HRSA , Medicaid , Pharmaceutical Industry , Prescription Drugs , Section 340B

Government Announces Health Care Fraud “Takedown”

Earlier today, Attorney General Loretta Lynch announced the largest coordinated crackdown in the Medicare Fraud Strike Force’s eight-year history. The government brought charges against 243 individuals for approximately $712...more

6/19/2015  /  Anti-Kickback Statute , Health Care Providers , Healthcare Fraud , Home Health Care , Home Healthcare Workers , Medicare , Medicare Fraud Strike Force , Medicare Part D , Nurses , Physicians

Mintz Levin Health Care Qui Tam Update - Recently Unsealed Whistleblower Cases: June 2015

Trends & Analysis: ..We have identified 33 health care–related qui tam cases that have been unsealed in whole or in part since the cases covered in our last Qui Tam Update. In addition, we have also identified one case...more

6/8/2015  /  Anti-Kickback Statute , Clinical Trials , False Claims Act (FCA) , Hospitals , Medical Devices , Qui Tam , Whistleblower Protection Policies , Whistleblowers

Over a Decade in the Making: CMS Releases Long-Awaited Medicaid Managed Care Rule

On May 27, 2015, the Centers for Medicare and Medicaid Services (“CMS”) published a 653-page proposed rule affecting the thirty-nine states (plus the District of Columbia) that use managed care organizations (“MCOs”) to...more

6/8/2015  /  Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Managed Care Contracts , Medicaid

3 Key Take Aways from AHLA’s Institute on Medicare and Medicaid Payment Issues

Last week I attended the American Health Lawyers Association Institute on Medicare and Medicaid Payment Issues in Baltimore, Maryland. Taking a comprehensive approach to reimbursement issues, the program offered a variety of...more

4/3/2015  /  Data Collection , Healthcare , Healthcare Fraud , Medicaid , Medicare , Professional Conferences

CMS Call Letter: Medicare Advantage Contracting Considerations

As a final addition to our series on the 2016 Draft Call Letter, we highlight some of the MA contracting issues raised by the Centers for Medicaid and Medicare Services (“CMS”). Specifically, CMS (1) recommends Medicare...more

3/9/2015  /  Centers for Medicare & Medicaid Services (CMS) , Healthcare , Managed Care Contracts , Medicare , Medicare Advantage
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