The U.S. Department of Justice (DOJ) announced on October 29 that Medtronic USA Inc. agreed to pay $8.1 million to settle allegations that it violated the False Claims Act (FCA) and federal Anti-Kickback Statute by paying kickbacks to a South Dakota neurosurgeon to use Medtronic’s medical devices. Medtronic will pay an additional $1.11 million for

The U.S. District Court for the Eastern District of New York has blocked the U.S. Department of Health and Human Services (HHS) from enforcing a new rule that limited sex discrimination in healthcare to discrimination based on gender as determined by biology. The rule, discussed in detail here in June, did not recognize sexual orientation

On June 23, the U.S. District Court for the District of Columbia ruled against the American Hospital Association and other associations and individual hospitals that had sued the U.S. Department of Health and Human Services (HHS) to block a new price transparency rule that will take effect on January 1, 2021. The rule, which was finalized

The U.S. Department of Health and Human Services (HHS) has finalized a new rule under Section 1557 of the Affordable Care Act in an effort to enforce civil rights laws and protect against discrimination in healthcare. The rule, entitled “Nondiscrimination in Health and Health Education Programs or Activities: Delegation of Authority,” attempts to restore civil

On April 27, the U.S. Supreme Court ruled in favor of commercial health insurers that were seeking $12 billion under the Affordable Care Act’s risk corridor program, acknowledging that the ACA “obligated the government to pay the full amount of risk corridor payments.”

The ACA established the risk corridor program to mitigate the risks assumed

New Jersey Governor Phil Murphy recently signed into law a package of nine bills that will preserve for state residents many of the provisions of the Affordable Care Act (ACA) even if the ACA itself is ultimately found unconstitutional. The new laws continue a trend among Democratic states that was previously discussed on Rivkin Rounds

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

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

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,

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