Jacqueline Glennon

Jacqueline Glennon

Cozen O'Connor

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Latest Posts › Centers for Medicare & Medicaid Services (CMS)

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Justice Department Continues Pattern of False Claims Act Suits Due to Alleged Kickbacks

On May 1, the federal government brought a False Claims Act (“FCA”) suit against three health insurers, as well as three insurance brokers. The Justice Department’s suit alleges that the insurers paid millions of dollars in...more

5/14/2025  /  Anti-Kickback Statute , Centers for Medicare & Medicaid Services (CMS) , Department of Justice (DOJ) , Enforcement Actions , False Claims Act (FCA) , Healthcare Fraud , Insurance Industry , Medicare , Medicare Advantage , OIG

CMS Announces 120-day Exception Period for No Surprises Act Independent Dispute Resolution

Under the No Surprises Act, “open negotiation” is the period of time during which payers must disclose to providers important information regarding the claim at issue. On June 14, 2024, CMS announced a 120-calendar-day...more

7/11/2024  /  Attestation Requirements , Centers for Medicare & Medicaid Services (CMS) , Cybersecurity , Department of Health and Human Services (HHS) , Department of Labor (DOL) , Health Care Providers , Healthcare , Negotiations , Surprise Medical Bills , U.S. Treasury , United Healthcare Insurance Co.

CMS Issues Final Rule Impacting Prior Authorization Process

Last week CMS issued its final rule “CMS Interoperability and Prior Authorization” (CMS-0057-F), unchanged from its proposed rule in 2022, which addresses prior authorizations. Prior authorization, a “utilization management”...more

1/24/2024  /  Centers for Medicare & Medicaid Services (CMS) , Children's Health Insurance Program (CHIP) , Final Rules , Medicaid , Medicare , Medicare Advantage , MIPS , Physicians , Prior Authorization , Provider Payments

UnitedHealthcare’s Changing Approach to Prior Authorizations

Prior authorizations, one of health insurers’ many “utilization management” techniques, is a hot topic amongst practicing physicians, patients, and regulators, to name a few. The prior-authorization process requires a health...more

7/14/2023  /  Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Health Insurance , Medicare Advantage , Physicians , Prior Authorization , United Healthcare Insurance Co.

HHS Proposes $9 Billion Lump Sum Payment for Hospitals to Remedy Unlawful 340B Payment Reductions

On Friday, July 7, 2023, the Centers for Medicare & Medicaid Services (CMS) published their long-awaited proposed remedy to the unlawful 340B drug payment reductions. Background: In 2018, CMS significantly reduced the...more

7/11/2023  /  Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Hospitals , Medicare , OPPS , Proposed Rules , Reimbursements
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