Tesch Leigh West

Tesch Leigh West

Morgan Lewis

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Falling Stars Ratings in Medicare Advantage Lead to Meteoric Payment Losses

The enormous impact of Medicare Stars Ratings on payments received by Medicare Advantage plans cannot be overstated. And with billions of dollars in bonus payments at stake, it may come as no surprise that stringent standards...more

12/2/2024  /  Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicare , Medicare Advantage , Medicare Advantage Organizations (MAOs)

Unpackaging CMS’s HOPPS Proposed Rule and Payments for Diagnostic Radiopharmaceuticals

In what can only be characterized as a necessary but significant proposed departure from current political initiatives focused on lowering pharmaceutical drug prices, the Centers for Medicare & Medicaid Services (CMS)...more

7/23/2024  /  Centers for Medicare & Medicaid Services (CMS) , Drug Pricing , Medicare , Medicare Part B , Pharmaceutical Industry , Prescription Drugs

Medicare Advantage: Managed Care Compliance in 2024

The Medicare program is broken down into four parts. Part A covers the cost of healthcare items and services provided during inpatient hospital stays as well as skilled nursing facility, hospice, and some home health care....more

3/21/2024  /  Centers for Medicare & Medicaid Services (CMS) , Fee-for-Service , Health Care Providers , Medicare , Medicare Advantage , Prescription Drugs

How the End of the PHE Will Impact the Healthcare Industry

The Biden administration announced on January 30, 2023 that the COVID-19 Public Health Emergency (PHE) would officially end on May 11, 2023. The PHE declaration, which first was issued by the Secretary of the US Department of...more

5/11/2023  /  Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Emergency Use Authorization (EUA) , Food and Drug Administration (FDA) , Life Sciences , Medicare , OCR , Public Health Emergency , Telehealth

CMS’s Final RADV Rule Announces No Extrapolation Methodology, No FFS Adjuster

The Centers for Medicare and Medicaid Services (CMS) issued a final rule on the use of extrapolation to determine overpayments in risk adjustment data validation (RADV) audits of Medicare Advantage organizations (MAOs) and...more

2/24/2023  /  Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicare , Medicare Advantage , Medicare Advantage Organizations (MAOs)

August Fast Break Recap – CMS Telehealth and RPM Updates

We hosted a very informative Fast Break session last month on CMS telehealth and RPM updates. If you weren't able to join us, the session was led by healthcare litigation associates Jake Harper and Tesch West, with special...more

9/10/2021  /  Centers for Medicare & Medicaid Services (CMS) , Consolidated Appropriations Act (CAA) , Coronavirus/COVID-19 , Health Care Providers , Medicare , Physician Fee Schedule , Proposed Rules , Telehealth , Telemedicine
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