Articles and Blogs

On February 15, 2018, the Office of Inspector General (“OIG”) released a report announcing the results of a review it conducted of outpatient hyperbaric oxygen therapy (“HBO therapy”) claims. Of the 120 sampled outpatient claims under review, OIG found payment was made in accordance with Medicare requirements for only 18 claims. The audit, included... READ MORE

NATIONAL Feds Take CMS to Task Over Improper Telehealth Reimbursements Medicare Advisers Recommend Payment Cuts To Many Free-Standing ERs Amazon drops plan to become a major pharmaceutical distributor 17 of the highest-paid CEOs in healthcare Staff recruitment and retention in the age of clinician shortages: 2 experts weigh in Millennial doctors care about culture... READ MORE

Consistent with earlier policy announcements, on April 3, 2018, the Antitrust Division of the U.S. Department of Justice (“DOJ”) announced that it reached a settlement with Knorr-Bremse AG and Westinghouse Air Brake Technologies Corporation (“Wabtec”), two large rail equipment suppliers. The settlement resolves a lawsuit alleging the companies had maintained unlawful agreements not to... READ MORE

NATIONAL Feds boast $2.4B in healthcare fraud judgments, settlements GAO Finds Several Medicare Beneficiary Data Vulnerabilities Feds, 30 states claim McKesson illegally repackaged cancer drugs to maximize profits Fitch identifies biggest issues facing nonprofit hospitals The Disappearing Doctor: How Mega-Mergers Are Changing the Business of Medical Care How to Ramp Up Physician Engagement at... READ MORE

NATIONAL Healthcare analytics market will be worth nearly $54 billion by 2025, report says A small but growing movement of doctors that don’t accept insurance and charge a monthly fee could be a model for big employers like Amazon and JPMorgan Walmart, Not Amazon, May Turn Out To Be The Real Health Care Disruptor... READ MORE

The Federal Policy for the Protection of Human Subjects (the “Common Rule”) regulates the conduct of human subject research supported by federal agencies. On January 19, 2017, the Department of Health and Human Services (“HHS”), as well as 15 other federal agencies and departments that are subject to the Common Rule, published significant changes to... READ MORE

NATIONAL What are the biggest challenges for telemedicine programs? Still no word on whether CMS will approve lifetime Medicaid limits Alere Pays $33.2M to Settle False Claims Act Allegations Nurses continue to push for safe staffing in DC Hospitals embrace interoperability: As data exchange matures, leaders find ways to use it to their advantage... READ MORE

We recently released an alert about the expiration of exception processes for the Medicare therapy caps as of January 1, 2018. Since that article, the Bipartisan Budget Act of 2018 was signed into law and includes a permanent fix to the therapy caps effective back to January 1, 2018. Therapy providers should review the... READ MORE

NATIONAL Tech’s Next Big Wave: Big Data Meets Biology Hospitals Acquired 5K Independent Practices from 2015 to 2016 CMS promises more APM’s, continued flexibility, better alignment of reporting tracks for MACRA CMS official: Moving physicians into advanced APMs under MACRA a ‘top strategic goal’ Five areas of the highest physician pay in the US... READ MORE

Last week, Cigna Corporation, the fifth largest health insurer in the country, and Express Scripts, the nation’s largest stand-alone pharmacy benefit manager (“PBM”), issued a statement outlining Cigna’s plans to acquire the PBM giant for $67 billion. This deal is just the latest example of a health insurer and PBM joining forces, coming just... READ MORE