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On October 31, 2011, the City of New York agreed to pay $70 million to settle False Claims Act allegations that the City violated New York state Medicaid regulations governing the Medicaid personal care services program.

CMS Publishes Final Medicare Physician Fee Schedule for CY 2012

November 2, 2011 | Blog | By Karen Lovitch

Yesterday CMS released the Medicare Physician Fee Schedule Final Rule for CY 2012, along with a press release and fact sheet summarizing key issues.
BioWorld Perspectives recently published an article by Mintz Levin attorneys Sam Davenport and Matt Hurley entitled “Avoiding Litigation While Protecting Your Interests,” which discusses the essential steps for companies to take after entering into a collaboration, license, or supply agreement to avoid ending up in litigation down the road.
On October 31, 2011,  President Obama signed and released an Executive Order directing the FDA and the Department of Justice to take actions  designed to reduce prescription drug shortages, protect consumers, and prevent price gouging regarding certain prescription drugs.
Today, CMS released the final rule that will implement the Medicare Shared Savings Program (MSSP) mandated by section 3022 of the Affordable Care Act.
ML Strategies has posted its weekly Health Care Reform Update providing timely information on implementation of the Affordable Care Act and other state and federal administrative and legislative activities related to health care reform.
Can a factually accurate claim submitted to the government for payment be “false or fraudulent" under the False Claims Act (FCA)? For many years, federal courts have grappled with the issue, as discussed in a Mintz Levin client advisory 

HHS OIG Reviews FY 2010 Recoveries by State MFCUs

October 17, 2011 | Blog | By Brian Dunphy

Last week, the OIG released an interesting interactive chart listing, by state, key statistics of state Medicaid Fraud Control Units (MFCU) for FY 2010. The statistics, while perhaps an imperfect comparison among the MFCUs, provide insight into the level of activity in each state, the total amount recovered by each MFCU, and the resources allocated to combat Medicaid fraud, waste, and abuse in each state.
In an Advisory Opinion long awaited by many in laboratory industry, the OIG concluded that a proposed arrangement that would have allowed physicians to profit from their own referrals for anatomic pathology services would “pose more than a minimal risk of fraud and abuse.” 

Manufacturers Still in the Dark About the Sunshine Act

October 11, 2011 | Blog | By Brian Dunphy

Manufacturers of pharmaceuticals, devices, and biological or medical supplies are well aware of an impending January 1, 2012 deadline to start collecting information for reports mandated by the federal “Physician Payments Sunshine Act,” which was part of health care reform legislation.
ML Strategies has posted its weekly Health Care Reform Update providing timely information on implementation of the Affordable Care Act and other state and federal administrative and legislative activities related to health care reform.

OIG Is Watching: FY12 Work Plan Focuses on Data Mining

October 10, 2011 | Blog | By Brian Dunphy

The Office of Inspector General released its Work Plan for Fiscal Year 2012 describing the focus of its activity for the next fiscal year. 
The Supreme Court has just heard oral argument in a case that raises the issue of whether Medicaid providers and recipients can challenge state decisions to cut Medicaid rates.
Emboldened by significant electoral gains in the 2010 midterm elections, Republican lawmakers have devoted significant time and attention to repealing “Obamacare.” 

When Is It Time to Pull the Plug in a Health Care Transaction?

October 6, 2011 | Blog | By Karen Lovitch

The Deal Pipeline recently published my article entitled Pulling the Plug?, which discusses the important question that many buyers must face in health care transactions: when is it time to walk away from the potential acquisition of a health care company that is under government investigation? 

HIPAA Isn't the Only Data Breach Law of Concern

October 6, 2011 | Blog | By Karen Lovitch, Dianne Bourque

In the event of a data breach, covered entities must consider state law notification requirements, as well as those imposed by HIPAA. Toward that end, Mintz Levin has developed a survey of state data breach notification laws, which is a useful tool for understanding the types of protections states require, breach notification triggers, timing, and other specifics.
ML Strategies has posted its weekly Health Care Reform Update providing timely information on implementation of the Affordable Care Act and other state and federal administrative and legislative activities related to health care reform.

Wisconsin Medicare Part C FCA Settlement for Business Misconduct

October 4, 2011 | Blog | By Ellyn Sternfield

In a  Medicare Part C (or “Medicare Advantage”) False Claims Act settlement announced by the Milwaukee-Wisconsin Journal-Sentinel on September 25th, an operator of a Germantown Wisconsin Medicare Advantage plan and its parent agreed to pay $4.8 million to settle allegations that the company improperly paid eligible individuals to enroll in the Medicare Advantage plans, then misled them about the scope of coverage. 
The split among the federal circuit courts over the “implied certification” of liability under the federal False Claims Act (FCA) is figuratively banging at the Supreme Court’s door.
House Subcommittee Chairman Rehberg (R-MT) unveiled his draft Labor, Health and Human Services, and Education appropriations bill that would cut $2.4 billion from 2011 funding levels, on Thursday.
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