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GAO Report Highlights Improper Medicare/Medicaid Payments
March 11, 2015 | Blog | By Samantha Kingsbury
Despite the efforts of the Department of Health and Human Services (HHS) to combat fraud and contain costs in federal healthcare programs, Medicare’s fee-for-service program (Parts A and B) and Medicaid were two of the top three culprits for the billions reported to have been improperly paid by the federal government in fiscal year 2014.
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CMS Call Letter: Medicare Advantage Contracting Considerations
March 6, 2015 | Blog | By Bridgette Keller
As a final addition to our series on the 2016 Draft Call Letter, we highlight some of the MA contracting issues raised by the Centers for Medicaid and Medicare Services (“CMS”).
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MA Risk Adjustment in the 2016 Call Letter and … in Health Care Fraud Charges
March 5, 2015 | Blog | By Tara E. Dwyer
In past Call Letters, CMS has proposed and finalized significant changes to the Medicare Advantage risk adjustment system including, recalibrations, deletions and additions of diagnoses codes, and questioning of the value of in-house health risk assessments.
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Mother Nature Axes 340B Hearing, But Written Testimony Survives
March 5, 2015 | Blog
Mother Nature claimed another victim this week. The U.S. House of Representatives Energy and Commerce Subcommittee on Health was scheduled to hold a hearing on March 5, 2015 – Examining the 340B Drug Pricing Program.
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CMS Call Letter: Provisions Related to Dual Eligible and Low Income Subsidy Individuals
March 5, 2015 | Blog | By Lauren Moldawer
For the last of our series on the 2016 Draft Call Letter, we focus on the provisions impacting plans serving Medicare-Medicaid, or dual eligible, enrollees. As we have previously posted, the Centers for Medicare & Medicaid Services (CMS) has struggled with how to provide high quality, seamless care to dual eligible individuals.
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CMS Call Letter: Pharmacy Network Implications
March 3, 2015 | Blog | By Theresa Carnegie
As part of our continuing series on CMS's 2016 Call Letter, we take a closer look at the provisions in the Call Letter affecting PBM and plan sponsor pharmacy networks. In the Call Letter, CMS raises concerns about preferred pharmacy networks and maximum allowable cost (MAC) pricing, and also provides clarifying guidance on mail order pharmacy auto-ship policies.
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Highlights From the FTC - DOJ Workshop Examining Health Care Competition
March 3, 2015 | Blog | By Theresa Carnegie
Last week, the Federal Trade Commission and the Department of Justice co-hosted the second installment of their public workshop series, “Examining Health Care Competition.”
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In Case You Missed It: Health Care Enforcement in 2015 Webinar
March 2, 2015 | Blog
Earlier this month, Mintz Levin’s Hope Foster and Bridget Rohde hosted a webinar entitled “Health Care Enforcement in 2015: A Look Back on 2014 and Forecasting the Year Ahead.”
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CMS Call Letter: Changes to and Implications of Star Ratings
March 2, 2015 | Blog | By Tara E. Dwyer
In its February 20, 2015 Advance Notice of Methodological Changes for Calendar Year (CY) 2016 for Medicare Advantage Capitation Rates, Part C and Part D Payment Policies and 2016 Call Letter, CMS addressed a variety of issues relating to its Star Ratings system.
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Supreme Court Rejects Antitrust Immunity for North Carolina Dental Board
February 27, 2015 | Blog | By Theresa Carnegie
On February 25, 2015, in a 6-3 decision authored by Justice Kennedy, the Supreme Court upheld the Federal Trade Commission’s decision finding that the North Carolina Board of Dental Examiners, although a state agency, was not exempt from federal antitrust laws when it sent 47 official cease-and-desist letters to non-dentist teeth whitening service providers.
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CMS Releases 2016 Draft Call Letter
February 26, 2015 | Blog | By Lauren Moldawer, Tara E. Dwyer
Last week, the Centers for Medicare & Medicaid (CMS) released its 2016 Advance Rate Notice and draft Call Letter (2016 Call Letter) for the Medicare Advantage (MA) and Medicare Part D programs.
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ML Strategies Posts Weekly Health Care Update on February 23, 2015
February 26, 2015 | Blog
ML Strategies has posted its weekly Health Care Update. This publication provides timely information on the Affordable Care Act implementation and other federal regulatory initiatives, and covers other updates affecting the health care industry.
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Telehealth Bill Moving Forward in Florida-But Medicaid Coverage Sacrificed
February 25, 2015 | Blog | By Ellen Janos, Carrie Roll
Last week, the Florida Senate Health Policy Committee removed language from proposed telehealth legislation that would require Medicaid reimbursement for telemedicine services at the same rates as face-to-face examinations.
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FTC-DOJ Workshop on Health Care Competition Enters Second Day
February 25, 2015 | Blog
The U.S.’s pursuit of lower health care costs and higher quality health care services has included the incentivizing of new organizational structures and payment models that trigger long standing concerns about maintaining competition in the health care system.
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CMS Delays 60-Day Rule, But Overpayment Case Law Emerging
February 24, 2015 | Blog | By Brian Dunphy
The Centers for Medicare & Medicaid Services (CMS) recently announced a one-year delay in finalizing the long-awaited and closely watched rule addressing the 60-day deadline to return Medicare and Medicaid overpayments (the “60-day rule”).
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ML Strategies Posts Weekly Health Care Update on February 17, 2015
February 20, 2015 | Blog
ML Strategies has posted its weekly Health Care Update. This publication provides timely information on implementation of the Affordable Care Act, Congressional initiatives affecting the health care industry, and federal and state health regulatory developments.
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Supplemental Excepted Benefits? "It depends."
February 19, 2015 | Blog | By Tara E. Dwyer
Last week, HHS, along with the Department of Labor and the Treasury, provided long overdue guidance regarding the third category of supplemental “excepted benefits” as defined by Section 2791 of the Public Health Services Act, Section 733 of ERISA and Section 9832 of the Internal Revenue Service Code.
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Device Manufacturer Settles False Claims Act Allegations with DOJ for $1.25 Million
February 18, 2015 | Blog | By Laurence Freedman, Samantha Kingsbury
The Department of Justice (DOJ) recently announced that ev3 Inc. (which acquired Fox Hollow Technologies, Inc. (“Fox Hollow”), a medical device manufacturer, in late 2007) agreed to pay $1.25 million to resolve allegations that Fox Hollow violated the False Claims Act (FCA) by causing certain hospital clients to submit false claims to the Medicare program.
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CMS Finalizes Policy Rules For Medicare Parts C and D
February 17, 2015 | Blog | By Theresa Carnegie, Lauren Moldawer, Bridgette Keller
Earlier this month, the Centers for Medicare & Medicaid Services (CMS) released its final rules on policy and technical changes to the Medicare Advantage (MA) and Prescription Drug Benefit programs (Part D) for contract year 2016.
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7th Circuit Court of Appeals Creates Expansive Definition of “Referral” Under the Anti-Kickback Statute
February 12, 2015 | Blog
On February 10, 2015, in United States v. Patel (Case No. 14-2607), the Seventh Circuit Court of Appeals ruled that a physician makes a “referral” within the meaning of the federal health care programs Anti-Kickback Statute (AKS).
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