StatLaw – June 2016

Emergency Room Physicians Sue the Department of Health & Human Services (“HHS”) over Out-of-Network Payments: The American College of Emergency Physicians (“ACEP”) recently filed a federal lawsuit against the HHS, claiming a provision of the Affordable Care Act (“ACA”) allows insurers to underpay for out-of-network emergency medical services. Under the ACA, insurers must pay the […]

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StatLaw – May 2016

UnitedHealth to Drop Out of Most Affordable Care Act Exchanges: In mid-April, UnitedHealth CEO Stephen Hemsley announced the company would pull out of most of its ACA marketplaces. However, the company will not withdraw from all the exchanges, and will continue to sell individual plans in what Mr. Hemsley said would be a “handful” of […]

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StatLaw – April 2016

CMS’ New Primary-Care Payment Model Projected to Affect 20,000 Physicians: The CMS’ new primary-care model seeks to reimburse practices with a monthly fee to manage care for as many as 25 million patients. This move marks the CMS’ largest plan to transform and improve how primary care is delivered and reimbursed across the nation. Titled […]

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StatLaw – March 2016

Physicians Question Whether CMS’ Part B Drug Proposal Plan Usurps Clinical Judgment, Cripples Specialists: Medicare’s overhaul of the way it reimburses doctors for more than $20 billion worth of outpatient drugs they administer each year has drawn criticism from physicians. Financially, although some physicians will receive higher payments, the current plan is economically disastrous to […]

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StatLaw – February 2016

District of Columbia Circuit Court Ruling Aims to Reduce RAC Appeals Backlog: After having its case dismissed by the trial court in December of 2014, the American Hospital Association’s (“AHA”) lawsuit seeking to force HHS to speed up RAC appeal decisions gained new life. The U.S. Court of Appeals for the District of Columbia Circuit reversed […]

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StatLaw – January 2016

New York State Department of Health Announces Online Medical Marijuana System:  The New York State Department of Health (“DOH”) announced the launch of its online Medical Marijuana Patient Certification and Registration System. The online system allows qualified patients to enroll in the Medical Marijuana Program so they will be able to purchase medical marijuana when […]

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StatLaw – December 2015

Supreme Court to Rule on Theory Underlying False Claims Act Suits: The United States Supreme Court recently granted certiorari in the case of Universal Health Services v. United States ex rel. Escobar. The case before the court focuses on one theory whistle-blowers and the government use in bringing False Claims Act (“FCA”) cases to court […]

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StatLaw – November 2015

CMS admits to underpaying dual-eligible health plans; issues with star ratings: The CMS recently released a highly technical document that, among other things, reveals it underpays health plans which enroll large numbers of people who are dually eligible for Medicare and Medicaid. To remedy that, the agency announced that it plans to modify its risk-adjustment […]

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StatLaw – October 2015

Medicare Unveils $30 Million Phantom Ambulance Rides: A federal audit released earlier this month revealed the pervasive problem with payments for patient transport. Primarily, the audit found numerous Medicare ambulance rides for which no records existed that the patients received any medical care at the hospital or facility where the patient was transported to. The […]

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StatLaw – September 2015

Federal Appeals Court Rules on Antitrust Issues in Hospital Medical Staff Case: In an opinion issued on August 20, 2015, the United States Court of Appeals for the Third Circuit ruled, in Novak v. Somerset Hospital, that a physician who brought an antitrust case against Somerset Hospital in Somerset, Pennsylvania, the hospital’s CEO and two […]

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StatLaw – August 2015

CMS’ National Fraud Prevention Program Authorizes Unannounced Site Visits for Medicare Part A/B providers and suppliers: In 2011, CMS implemented a site visit verification program using a National Site Visit Contractor (NSVC). The site visit verification program is a screening mechanism to prevent questionable providers and suppliers from enrolling or maintaining enrollment in the Medicare […]

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StatLaw – July 2015

Congressional Hearing Highly Critical of CMS over Medicare Fraud and Opioid Abuse: At a recent Congressional Hearing, CMS was slammed for its failure to implement “commonsense recommendations.” Rep. Tim Murphy (R-Pa.), chair of the House Energy and Commerce Subcommittee on Oversight and Investigations, further alleged that CMS’ failure to implement such measures “has led to […]

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StatLaw – June 2015

OIG Issues Fraud Alert Concerning Physician Contracts that Violate the Anti-Kickback Statute: The Department of Health and Human Services’ Office of Inspector General recently issued a fraud alert on the heels of a dozen recent settlements involving physician contracts. The alert likely indicates that the OIG is increasingly pursuing allegations against individual doctors, not just […]

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StatLaw – May 2015

The Office of the National Coordinator for Health Information Technology (ONC) Releases Version 2.0 of its Guide to Privacy and Security of Electronic Health Information: The ONC’s updated Guide provides valuable information and offers practical scenarios that help explain, among other things, when a business associate (BA) relationship forms. The Guide offers suggested questions health […]

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StatLaw – April 2015

Open Payments Physician Review and Dispute Period Began on April 6 and will last for 45 days: As part of the Open Payments program (“Sunshine Law”) physicians and teaching hospitals can review payments attributed to them beginning on April 6, 2015. Drug and medical device makers (“Applicable Manufacturers”) are required to report certain payments made […]

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StatLaw – March 2015

Federal Appeals Court Decision Makes for More Uncertainty in RAC Program: Medicare’s recovery audit contractor (“RAC”) program has been plagued with uncertainty for more than a year, and a recent decision of the United States Court of Appeals for the Federal Circuit is simply adding to the confusion. In CGI Federal, Inc. v. United States, […]

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