Health Care Counsel Blog

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A federal district court vacated in its entirety the Centers for Medicare and Medicaid Services’ (CMS) regulations regarding the reporting and returning of overpayments by Medicare Advantage plan insurers.  
On September 11, 2018, hospital advocacy groups and three individual hospitals filed a complaint in the United States District Court for the District of Columbia.
Health care plans are seeing an increase in the number of claims from their enrollees for reimbursement for mental health, behavioral, and substance abuse services obtained at “wilderness camps.”
Health chart
On August 28, 2018, the United States District Court for the Eastern District of California (the Court) dismissed with leave to amend the Pharmaceutical Research and Manufacturers of America’s (PhRMA) lawsuit challenging the constitutionality of California’s new drug price transparency law.
The Department of Health and Human Services Office of the Inspector General published a request for information seeking public comments on what new or modified safe harbors to the Anti-Kickback Statute or exceptions to the beneficiary inducements prohibition.
The Centers for Medicare & Medicaid Services has released its “Proposed Changes to Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs” for calendar year 2019 (the Proposed Rule).
On July 24, 2018, the United States Court of Appeals for the Fourth Circuit denied the State of Maryland’s petition for an en banc rehearing of the Fourth Circuit’s April 13, 2018 decision in the matter of Association of Accessible Medicines v. Frosh.
In a decision that all hospitals should be aware of, on July 9, 2018, the Tenth Circuit reversed a lower court’s dismissal of a False Claims Act case against a physician and two hospitals based on allegations that the physician’s procedures were not medically necessary or reasonable.
The Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2019 Proposed Rule (the Proposed Rule) is scheduled to be published in the Federal Register on July 27, 2018.
On Friday, July 13, 2018, the California Office of Statewide Health Planning and Development (OSHPD) posted proposed regulations implementing California’s drug price transparency law.
As the most recent state to address the issue of what to do with unused medications, on July 10, 2018, New York Governor Andrew Cuomo signed the Drug Take Back Act (the Act).
The ABA Young Lawyers Division Health Law Committee and ABA Health Law Section is hosting a networking reception followed by a roundtable discussion with senior government attorneys from CMS, DOJ, and OIG.
On June 28, 2018, the Pharmaceutical Research and Manufacturers of America (PhRMA) and Biotechnology Innovation Organization (BIO) dropped their lawsuit challenging the constitutionality of Nevada’s recent drug price transparency law.
In-house counsel for health industry organizations face unique challenges – but those challenges can be met.
On June 20, 2018, the Centers for Medicare & Medicaid Services issued a Request for Information seeking input from the public on how to address the undue regulatory impact and burden imposed on health care providers under the Stark Law.
Geoffrey Starks testified on Wednesday, June 20, 2018 before the Senate Committee on Commerce, Science, and Transportation.
Edwin Simcox, Acting Chief Technology Officer for the US Department of Health and Human Services (HHS), lauded telehealth as an innovation that potentially offers ways to address HHS’s four key priorities.
The Department of Health and Human Services OIG has issued an advisory opinion approving an arrangement involving the provision of free telemedicine equipment and services by a provider to a potential referral source.
The California Office of Statewide Health Planning and Development (OSHPD) has posted a preliminary working draft of the regulations implementing California’s prescription drug price transparency law.
Connecticut and Maine recently joined the increasing number of states to enact drug price transparency laws. Maine’s drug price transparency law (the Maine Law) became effective on May 1, 2018.
The Centers for Medicare and Medicaid (CMS) is overhauling the Electronic Health Records (EHR) Medicare and Medicaid program for hospitals.
On May 17, 2018, CMS issued a strongly-worded letter to Part D plan sponsors stating that pharmacy “gag clauses” are unacceptable.
In a recent decision, the US Court of Appeals for the Ninth Circuit held that a surgical center lacked standing to bring ERISA claims against a health plan because the plan had a valid anti-assignment provision.
Following delays and much build up, the White House and the Department of Health and Human Services (HHS) have released their plan to address rising pharmaceutical prices and out-of-pocket costs directly impacting patients.
Medicaid expansion continues to be a hot button issue in the numerous states that have yet to expand the program under the Affordable Care Act of 2010 (“ACA”), and the latest battlefield is a Maine courthouse.