Affordable Care Act


Life Spine Settles FCA Kickback Case for $6 Million
October 31, 2019 | Eric D. Fader | Affordable Care Act | False Claims Act | Fraud and Abuse | Litigation | Medical Devices and Wearables | Medicare and Medicaid
Spinal implant manufacturer Life Spine Inc. and two of its executives have settled their False Claims Act case by agreeing last week to pay the federal government $6 million. As discussed here, the company and executives had been accused of paying kickbacks to surgeons to use the company’s products. In addition to paying $5.5 million …
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Kickback Charges Lead to False Claims Act Case
August 27, 2019 | Eric D. Fader | Affordable Care Act | False Claims Act | Fraud and Abuse | Litigation | Medical Devices and Wearables | Medicare and Medicaid
The Manhattan U.S. Attorney’s Office recently announced that the U.S. Department of Justice has intervened in a whistleblower suit against Life Spine Inc., an Illinois-based manufacturer of spinal implants, devices and equipment. The lawsuit, which seeks damages and civil penalties under the False Claims Act (FCA), claims that Life Spine paid millions of dollars in …
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CMS Adds Health Plan Ratings to ACA Exchanges
August 20, 2019 | Eric D. Fader | Affordable Care Act | Legislation and Public Policy | Medicare and Medicaid | Private Insurers
The Centers for Medicare & Medicaid Services (CMS) announced on August 15 that health plans offered on health insurance exchanges will be ranked using a five-star quality rating system for the 2020 plan year open enrollment period that begins on November 1, 2019. The ratings will appear on both state-based exchanges and the federal exchange, …
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OIG Audit Reveals NY Medicaid Eligibility Errors
July 25, 2019 | Margarita Christoforou | Affordable Care Act | Legislation and Public Policy | Medicare and Medicaid
Based on a recent audit of payments under New York’s Medicaid program, the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) estimated in a report that the state made hundreds of millions of dollars in payments to ineligible or “potentially ineligible” beneficiaries. The audit examined payments to “non-newly eligible” beneficiaries, meaning …
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States Pick Up ACA Slack
July 12, 2019 | Eric D. Fader | Affordable Care Act | Legislation and Public Policy | Private Insurers
With the political battle over the future of the Affordable Care Act (ACA) dragging on in Washington, a number of states have recently taken steps to protect their residents from potential instability in the health insurance market. New Jersey is setting up its own state health insurance exchange to replace the federally run healthcare.gov marketplace, …
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New York State Budget Includes ACA-Type Protections
April 3, 2019 | Eric D. Fader | Affordable Care Act | Home Health | Hospitals | Legislation and Public Policy | Medicare and Medicaid | Private Insurers
New York’s state budget for the 2019-2020 fiscal year, approved by the State Legislature on March 31, included provisions that codify into state law the primary consumer protections of the federal Affordable Care Act. In a public announcement, Gov. Andrew Cuomo said, “We have codified many of the protections of Obamacare, so regardless of what …
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New Jersey to Set Up State Health Insurance Exchange
March 26, 2019 | Eric D. Fader | Affordable Care Act | Legislation and Public Policy | Private Insurers
New Jersey Governor Phil Murphy announced on March 22 that the state will create its own health insurance exchange for plan year 2021, replacing the federally run healthcare.gov marketplace. Gov. Murphy also gave notice of the change by sending a Declaration of Intent Letter to the federal government’s Center for Consumer Information and Insurance Oversight. …
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Healthcare: The Next Frontier
March 5, 2019 | Rivkin Rounds Staff | Affordable Care Act | Employer/Employee | Hospitals | Legislation and Public Policy | Private Insurers
A March 1 article in Long Island Business News entitled “Healthcare: The next frontier” discussed the issues raised at a recent roundtable discussion on the current state of the healthcare industry. The panel included Rivkin Radler partners Robert Iseman and Benjamin Malerba; Dr. Zeyad Baker, ProHEALTH Care Associates’ president and CEO; Jeffrey Kraut, executive vice …
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FTC Investigations Could Bring Unwanted Scrutiny to Hospitals
January 18, 2019 | Rivkin Rounds Staff | Affordable Care Act | Antitrust | Hospitals | Legislation and Public Policy | Litigation | Private Insurers
An article in Relias Media’s Healthcare Risk Management newsletter, “FTC Investigations Could Bring Unwanted Scrutiny to Hospitals,” discussed potential investigations of hospitals’ anti-competitive behavior by the Federal Trade Commission.  Rivkin Radler’s Robert H. Iseman was featured prominently in the article. Bob noted that hospitals and health systems that are considered “must-have” participants in health insurance plans face …
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Starting the New Year with Hospital Price Transparency
January 8, 2019 | Cassandra Rivais DiNova | Affordable Care Act | Hospitals | Legislation and Public Policy | Medicare and Medicaid
As of January 1, hospitals are now required to post charges for their standard items and procedures online in an effort to increase price transparency. Section 2718(e) of the Public Health Service Act, part of the Affordable Care Act, requires each hospital in the U.S. “for each year [to] establish (and update) and make public …
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