Articles and Blogs

Addressing “Surprise” Medical Bills High Priority for Administration and Congress Yesterday, President Trump held an address at the White House where he emphasized that Congress should act to “hold insurance companies and hospitals totally accountable” for surprise medical bills. A surprise medical bill, more commonly known as balance billing, occurs when patients, through no... READ MORE

The Centers for Medicare & Medicaid Services (“CMS”) recently published a final rule (“Final Rule”) revising the procedures that CMS uses to administer its Preclusion List. As outlined below, CMS now requires Medicare Advantage, Medicare Part D and other designated plans to deny payment for items or services provided by or prescribed by a... READ MORE

NATIONAL Costs for the same medical procedures show wide variation between hospitals CBO: HHS’ rebate rule would boost federal spending by $177B, lead to higher Part D premiums Trump administration announces ‘conscience rule’ for health care providers CMS lays out strategy to foster medical innovation in Medicare CVS exec: ‘We don’t discount Amazon’ Hospitals... READ MORE

On April 22, 2019, the Centers for Medicare & Medicaid Services (“CMS”) announced a new set of value-based payment models for reimbursement of primary care services. CMS has coined the new models its “Primary Cares Initiative.” Although participation in the models is currently voluntary, CMS hopes the initiative will accelerate the nationwide transition of... READ MORE

The U.S. government’s unilateral investigative powers under the False Claims Act were bolstered by a ruling from the U.S. District Court for the Eastern District of California last week. Ruling on a Petition for Summary Enforcement of a Civil Investigative Demand (“CID”), the court held: Settlement discussions with a person or entity involved in... READ MORE

In keeping with the trends of the commercial market, on April 22, 2019, the Centers for Medicare & Medicaid Services (“CMS”) announced opportunities to participate in new direct contracting models under Medicare’s Part A and Part B fee-for-service program. CMS intends to focus these models particularly on primary care coordination for medically complex and... READ MORE

On May 6, 2019, the United States District Court in Washington, D.C. issued its opinion on the appropriate remedy to address the invalidated payment cuts set forth in the 2018 and 2019 Outpatient Prospective Payment System final rules (“2018 and 2019 OPPS Rules”) for drugs purchased under the 340B drug discount program (“340B Program”).... READ MORE

On May 3, 2019, CMS released its long-awaited guidance on hospital co-location and shared service arrangements in the form of a draft survey memo (“Memo”), which is available here. The Memo clarifies how a hospital can co-locate with other health care entities without violating the Medicare Conditions of Participation (“CoPs”). CMS has been promising... READ MORE

NATIONAL How hospitals are making investments that create new revenue streams Civica Rx CEO predicts ‘stampede’ if Amazon’s Haven succeeds HHS cuts maximum civil monetary penalties for HIPAA violations Healthcare sweeps ranking of top-paying jobs — Salaries for surgeons, orthodontists & more PBM executive: Industry has been discussing end of rebates for a ‘long,... READ MORE

Hall Render is pleased to announce that Chambers and Partners has recognized Joe Kahn in its 2019 Chambers USA rankings. Joe received a Band 1 ranking for Healthcare in North Carolina. Focusing his practice on transactions and affiliations, he was praised as a “strategic thinker” who “understands the industry and is very well respected.” Chambers... READ MORE