Articles and Blogs

HELP Committee Passes Mental Health Legislation On March 16, the Senate Health, Education, Labor and Pensions (“HELP”) Committee passed a set of bipartisan mental health and opioid abuse bills that include provisions relating to access to care, early intervention and shortages in the behavioral health workforce.

In a proposed rule issued on March 11, CMS formally unveiled plans for its Part B Drug Payment Model (the “Model”). The Model would significantly alter how Medicare pays for Part B drugs and biologicals. If finalized, the Model will affect hospital outpatient departments, physicians, nursing facilities and certain DME suppliers. Commencement and Duration of…Read More

The Sixth Circuit Court of Appeals, in US ex rel. Sheldon v. Kettering Health Network, affirmed the dismissal of a False Claims Act (“FCA”) suit alleging fraud based upon certifications of compliance with the HITECH Act and a data breach. The HITECH Act, or Health Information Technology for Economic and Clinical Health Act, encourages the adoption…Read More

CMS Proposes Overhaul of Part B Drug Payments On March 8, CMS announced a proposed rule to change the way it pays for billions of dollars of drugs covered by Medicare. The new project, run through the Center for Medicare and Medicaid Innovation (“CMMI”), would allow the government to vary what it spends on drugs…Read More

Wisconsin became the twelfth state to enact the Interstate Medical Licensure Compact (“Compact”) into law, which, once implemented, will allow eligible physicians the option of applying for a medical license through an expedited process in Wisconsin and other states participating in the Compact. With physician shortages increasing, the Compact is intended to expand access to health…Read More

On March 1, 2016, the Department of Justice (“DOJ”) released a statement describing a settlement with the United States’ largest endoscope distributor (“Company”) to resolve civil claims and criminal charges connected to payments and kickbacks made to physicians and hospitals. The Company agreed to pay a total of $623.2 million to settle the criminal penalties…Read More

Overview On March 1, 2016, the Centers for Medicare & Medicaid Services (“CMS”) issued a Proposed Rule that would make several sweeping changes to the Medicare screening and enrollment requirements for providers and suppliers. In particular, the Proposed Rule would require providers and suppliers to report certain affiliations with other providers/suppliers that may pose a…Read More

Executive Summary The Centers for Medicare & Medicaid Services (“CMS”) recently released a memo to Medicare Advantage and Part D plan sponsors (collectively, “Sponsors”) providing additional guidance regarding Compliance Program Effectiveness (“CPE”) training requirements applicable to a Sponsor’s first tier, downstream and related entities (“FDRs”), including a Sponsor’s contracted health care providers and subcontractors. In…Read More

House Approves Legislation to Reduce Medicaid Fraud On March 2, the House of Representatives unanimously passed a bill to improve program integrity in Medicaid and CHIP. The Ensuring Removal of Terminated Providers from Medicaid and CHIP Act (H.R. 3716) would help states identify health care providers whose participation in Medicaid or CHIP was terminated in…Read More

Overview Since the passage of the Affordable Care Act, all Medicare providers and suppliers have been required to revalidate their Medicare enrollment information under new screening criteria. The Centers for Medicare & Medicaid Services (“CMS”) has implemented this requirement in two cycles. The first cycle of revalidation requests has concluded, and CMS is preparing to…Read More