Perspectives on Health Care
406 total results. Page 1 of 17.
A Pebble in the Pond? Potential Ripple of a Court Decision to Vacate the Medicare Part C/D 60-Day Overpayment Rule
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 Partner Stephanie Trunk was interviewed by HealthLeader on a recent ruling that vacated the Medicare Advantage 2014 Overpayment Rule.
Emerging Frontier of Health Plan Litigation: Reimbursement Claims and Lawsuits on the Rise for Mental Health Treatment at Wilderness Camps
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.”
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.
Seize the Opportunity: HHS Seeks Stakeholder Input on AKS Safe Harbors and CMP Exceptions to Ease Regulatory Burdens on Care Coordination
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.
Health Care associate Harsh Parikh was appointed to the joint LACBA-LACMA Committee on Biomedical Ethics for the 2018-2019 period.
It’s About More Than Hospitals: CY 2019 Proposed Hospital Outpatient Prospective Payment System Rule Contains Proposals of Interest to the Pharmaceutical Industry
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).
Fourth Circuit Denies Maryland’s Request for En Banc Rehearing: Drug Price-Gouging Law Remains Unconstitutional
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.
Medical Judgment v. Objective Falsity: Hospitals Must Defend FCA Action Over Disputed Medical Necessity Claims Related To Physician’s Medical Judgment
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.
CY 2019 Medicare Physician Fee Schedule and Part B Proposed Rule Signals Payment Reduction for New Part B Drugs
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.
Proposed Regulations Implementing California’s Drug Price Transparency Law Available for Public Comment
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.
New York Law Imposes Drug ‘Take Back’ Obligations on Manufacturers, Pharmacies, and Wholesalers, with Manufacturers Footing the Bill
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.
Fifth Circuit: Complaints Seeking Plan Benefits Need Not Quote Provisions, Especially When Insurers Refuse to Provide Documents
The Fifth Circuit recently held that plaintiffs seeking benefits, under plans governed by the Employee Retirement Income Security Act of 1974 and non-ERISA plans, need not identify and include specific plan provisions in their complaints to survive motions to dismiss.
Speak Now or Forever Hold Your Peace: CMS Requests Provider Input on Relaxing Stark Law with Focus on Care Coordination
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.
Special Report Examines Every Individual Charged with Civil and Criminal FCPA Violations During Last 13 Years
The US Department of Justice remained busy in its first year of the Trump Administration, charging 20 individuals with violations under the US Foreign Corrupt Practices Act — the second highest year of individual prosecutions since 1977.
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.