Articles and Blogs

Providers and payers alike are increasingly exploring ways to treat the “whole person” by integrating behavioral health care with physical medicine. This integration is critical to helping achieve better outcomes and increasing quality of care. Achieving full integration has proven to be quite challenging, including navigating the legal and compliance requirements when designing and implementing…Read More

CBO Unveils Revised Analysis of AHCA On May 24, the Congressional Budget Office (“CBO”) released its estimate of the economic and coverage impact of the American Health Care Act (“AHCA”), the House-passed bill to repeal and replace the Affordable Care Act (“ACA”). While CBO stressed the uncertainty of its estimate given the need to project…Read More

Senate Finance Committee Advances Telemedicine Bill On May 18, the Senate Finance Committee passed the bipartisan CHRONIC Care Act (S. 870), which contains a number of telemedicine-related provisions. The measure allows Medicare to pay for remote stroke diagnosis and treatment, ACOs to provide telemedicine and Medicare Advantage plans to offer telemedicine as a supplemental benefit,…Read More

Executive Summary: Dahlstrom v. Sauk-Suiattle Indian Tribe, No. C16-0053JLR, 2017 WL 1064399 (W.D. Wash. Mar. 21, 2017) On March 21, 2017, a federal judge agreed with the Sauk-Suiattle Indian tribe (the “Sauk-Suiattle” or the “Tribe”) that it could not be sued under the federal False Claims Act (“FCA”) due to the tribe’s immunity from suit…Read More

On May 18, 2017, the Centers for Medicare & Medicaid Services (“CMS”) published a final rule (the “Final Rule”) effectively postponing the start date of CMS’s new episode payment models (“EPMs”) and the Cardiac Rehabilitation Incentive Payment Model (“CR Incentive Model”) from July 1, 2017 until January 1, 2018. The Final Rule also delayed the…Read More

In a May 15, 2017 7-1[1] decision authored by Hon. Justice Kagan, the U.S. Supreme Court held that the Kentucky Supreme Court’s “clear statement rule” – that an agent can deprive her principal of the rights of access to the courts and trial by jury through an arbitration agreement only if expressly provided in the…Read More

On May 12, 2017, a massive cyber attack affecting health care organizations across the world prompted the United States Department of Health and Human Services (“HHS”) to issue a warning to U.S. health care organizations. The attack apparently first began in England, causing information systems at health care organizations throughout the country to become infected with…Read More

Senate Begins Work on AHCA Senate Republicans began working on the House-passed American Health Care Act (“AHCA”) this week. Several expected changes to the measure include increasing funding for rural hospitals that lose subsidies under Affordable Care Act (“ACA”) repeal, providing a larger share of tax credits to lower income consumers nearing Medicare age (aged…Read More

On May 10th and May 12th, respectively, CGS Administrators, LLC (“CGS”) and Wisconsin Physician Services, Inc. (“WPS”) issued clarifications related to the MACs’ Local Coverage Determinations (“LCDs”) for polysomnography and other sleep studies. Click here for background on these LCDs. Due to efforts by state hospital associations, the MACs recognized that some hospitals relied on…Read More

On May 1, 2017, the United States Court of Appeals released an important decision interpreting the False Claim Act’s (“FCA’s”) materiality requirement in light of the Supreme Court’s 2016 decision in Universal Health Services Inc. v. United States ex rel. Escobar. The case, United States ex rel. Petratos v. Genentech, revolved around allegations regarding the cancer…Read More