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Prior Authorization Enforcement

Vinson & Elkins LLP

Prior Approval Remedies in M&A: Agency Policy and Practice

Vinson & Elkins LLP on

For twenty-five years prior to the Biden Administration, FTC and DOJ consent agreements have had a singular goal: to remedy the anticompetitive effects of proposed transactions. Under former Chair Khan, however, the FTC...more

Health Care Compliance Association (HCCA)

[Webinar] CMS Issues Additional Guidance to Clarify new MA Regulations - October 8th, 12:00 pm - 1:30 pm CT

Learning Objectives: - Discuss the new regulations and subsequent CMS guidance applicable to MAOs regarding coverage criteria and prior authorization - Discuss the broader current landscape between MAOs and providers,...more

Keating Muething & Klekamp PLL

Benefits Monthly Minute - August 2023

The August Monthly Minute presents Part II of our mental health parity update and provides highlights of the latest report to Congress on NQTL comparative analyses. While service providers lead the way through mental health...more

Harris Beach Murtha PLLC

OIG Enforcement Summary: July 16, 2022 – July 31, 2022

The following is a summary of the federal Department of Health and Human Services’ Office of Inspector General (OIG) reports of fraud and abuse enforcement activity across the country. The enforcement actions reported are...more

Perkins Coie

FTC Revives and Expands “Prior Approval” Policy

Perkins Coie on

On October 25, 2021, the U.S. Federal Trade Commission (FTC) released its “Statement on Use of Prior Approval Provisions in Merger Orders” (the Statement). The Statement announces two material changes in the agency’s merger...more

Baker Donelson

Medicare Proposes Prior Authorization Process for Certain DMEPOS Items

Baker Donelson on

On May 28, 2014, CMS issued a proposed rule to establish a permanent prior authorization process for certain durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) items that are “frequently subject to...more

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