Articles and Blogs

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 add…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 primary…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 a…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 seriously…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”). The…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 this…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, long…Read More

On April 23, 2019, the Centers for Medicare & Medicaid Services (“CMS”) released the Federal Fiscal Year (“FFY”) 2020 Medicare Inpatient Prospective Payment System (“IPPS”) proposed rule (“IPPS Proposed Rule”). Among many other changes, CMS proposed several changes to address disparities between high and low wage index areas and fixing the so-called “rural floor.” CMS…Read More

NATIONAL 75% of healthcare experts struggle with implementing blockchain What’s next for the post-Gottlieb FDA Hospitals can only watch as big players move in on primary care The 10 best and 10 worst states for children’s healthcare HHS extends comment period for interoperability proposed rules to June 3 Cerner and naviHealth launch EHR-agnostic tool to…Read More

The Office of Inspector General for the U.S. Department of Health and Human Services (OIG) recently unveiled the use of a new tool called the Fraud Risk Indicator. OIG’s stated purpose behind this new initiative is to provide more transparency to industry stakeholders (e.g., patients, family members, healthcare industry professionals) regarding OIG’s risk assessment of a party…Read More