On July 11, 2014, the Center for Medicare and Medicaid Services (“CMS”) published its proposed annual update to the Medicare
A San Diego pharmaceutical company will pay more than $11 million to the Justice Department to settle allegations that it improperly induced doctors to prescribe its products.
The D.C. Circuit has reversed a decision that excluded three pharmaceutical executives from Medicare and Medicaid for 12 years.
The Court was hearing an appeal of the punishment of Michael Friedman, Paul Goldenheim, and Howard Udell – all executives at Purdue Pharma, a company that was convicted of misbranding the painkiller OxyContin.
The American Hospital Association (AHA) and four hospitals have filed suit against the Department of Health and Human Services, seeking to end what the plaintiffs call an “unlawful government practice.”
Kentucky Spirit, one of the three Medicaid managed care companies serving Kentucky, has informed the Cabinet for Health and Family Services of its intention to prematurely terminate its three-year contract.
Regulatory overhauls are in full swing, particularly in the areas of reimbursement, technology, and accountability. Concern over the changing landscape has renewed health care providers’ interest in discussions regarding collaboration and consolidation.
The state of Kentucky has decided to delay the implementation of its of Medicaid managed care system by one month. The start-up date will now be November 1st.
One key concept in Medicare reform is to base payments on the quality of care, rather than the quantity. In other words, Medicare payments in the future will in part be based on the results providers achieve for patients, rather than the number of procedures they provide. Over the next several years, the Centers for Medicare and Medicaid Services (CMS) will be implementing quality initiatives in an effort to improve care and reduce costs. To achieve the results mandated by these new quality initiatives, providers should be making plans to implement necessary changes and to incentivize physicians to assist providers in reaching quality benchmarks.
On December 3, 2010, the acting United States Solicitor General filed the long-awaited amicus curiae brief of the United States in the case of Maxwell-Jolly v. Independent Living Centers of California. Independent Living Centers is a preemption case brought by Medicaid providers to challenge cuts in the California Medicaid reimbursement rates. The brief comes on the heels of the Department of Health and Human Services’ (HHS) denial on November 18, 2010 of California State Health Plan amendments that would have implemented the rate cuts. The brief and the recent actions of HHS make this case, which once seemed destined to be heard by the Supreme Court, to now appear to be a doubtful petition for certiorari.
The new healthcare reform legislation known as the Patient Protection and Affordable Care Act of 2010 (PPACA) has significantly increased potential liability for healthcare providers. The PPACA includes new provisions designed to reduce fraud and abuse in the healthcare system; however, the new provisions make it possible for healthcare providers to inadvertently run afoul of anti-fraud statutes.