Articles and Blogs

NATIONAL Verma puts Medicaid insurers on notice, says CMS will begin ‘targeted audits’ While surgery centers support CMS payment proposal, hospital groups submit harsh criticism Supreme Court to hear DSH payments case Banner Health, Ascension executives join hundreds of hospital CEOs defending 340B program MGMA shares physician practice keys to success MGMA18: Underwhelming MIPS payments…Read More

On September 17, 2018, the U.S. Department of Justice (“DOJ”) approved the $52 billion vertical merger between health insurer Cigna Corp. (“Cigna”) and pharmacy benefit manager (“PBM”) Express Scripts. The Cigna-Express Scripts merger is just one in a string of recent health insurer/PBM acquisitions. For more on these transactions, click here. As the largest unaffiliated PBM…Read More

They’re at it again! On August 28, 2018, the Department of Labor’s Wage and Hour Division issued six opinion letters. This was the second batch of opinion letters from the Wage and Hour Division in a matter of months. The Wage and Hour Division, which hadn’t published new opinion letters since 2010, previously issued three…Read More

A recent denial of summary judgment by a U.S. District Court in New York reminds us that bias-based comments can have serious consequences for hospitals and other employers, including that their employment decisions may be undermined. The ruling also suggests that, in certain situations, requiring a waiver of claims may be considered retaliatory. Facts and…Read More

Congress Sends Health Funding Package to President Congress completed the funding package for the 2019 Labor-HHS appropriations measure, which hikes funding for most Health and Human Services (“HHS”) agencies. On Wednesday, the House of Representatives voted, 361 to 61, to pass legislation to provide $178.1 billion in discretionary funding for the departments of Defense, Labor,…Read More

NATIONAL How providers can innovate to combat physician burnout CMS: Innovative new payment models are coming—and some will be mandatory Lack of consistent process hinders data sharing among HHS agencies, report finds Apple Watch Should Pave Way for More Medical Gadgets, FDA Says Pharma lobby mounts last-ditch effort to fix prescription ‘doughnut hole’ Less Than…Read More

On July 12, 2018, the Centers for Medicare & Medicaid Services (“CMS”) released its proposed rule for the Calendar Year (“CY”) 2019 Medicare Physician Fee Schedule (“Proposed Rule”). Among many other changes, CMS proposed numerous modifications to the required documentation for evaluation and management (“E/M”) visits in order to alleviate the administrative burden on practitioners and to…Read More

Hospitals in Illinois received good news last week when, after years of litigation in state court, the Illinois Supreme Court in Oswald v. Hamer[i] upheld the constitutionality of Section 15-86 of the Illinois Property Tax Code, which addresses tax exemptions for hospitals. While this decision allays recent uncertainty surrounding hospital property tax exemptions and gives…Read More

The past several years have seen a trend of attorneys now taking on the role of relator as well as counsel. This raises a new question: how are relators who act as counsel to be rewarded? By the relator’s share? By attorneys’ fees? By both? That question was answered recently by the Illinois Supreme Court, interpreting the…Read More

The Department of Health and Human Services Office for Civil Rights (“OCR”) fined three separate hospitals a cumulative total of $999,000 to settle potential violations of HIPAA arising from allowing film crews on premises to film a reality television show without first obtaining patient authorizations. The OCR Resolution Agreement can be found here. Generally, a covered…Read More