Legislation and Public Policy


Primary Care Payment Model Delayed to 2021
November 4, 2019 | Eric D. Fader | Hospitals | Legislation and Public Policy | Medicare and Medicaid | Private Insurers
The Center for Medicare & Medicaid Innovation, part of the Centers for Medicare & Medicaid Services, recently released its Request for Applications for the new “Primary Care First” payment model. The program will now begin in 2021 rather than the 2020 start date that was originally proposed in April, as discussed here. CMS said it …
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Shapiro to Present on Nutrition Labeling Regulations for the AHPA
October 23, 2019 | Rivkin Rounds Staff | FDA | Legislation and Public Policy
Steven Shapiro will be a speaker on a webinar offered by the American Herbal Products Association (AHPA) entitled “Compliance with FDA’s Revised Nutrition Labeling Regulations for Herbal Supplements.” Scheduled for October 29 from 1-3 pm, the program will offer an overview of new federal nutrition labeling requirements, which take effect Jan. 1, 2020, for manufacturers …
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CMS Announces New Medicare Program Integrity Strategy
October 23, 2019 | Eric D. Fader | Fraud and Abuse | Home Health | Legislation and Public Policy | Medicare and Medicaid
In an October 21 blog post titled “The Future of Medicare Program Integrity,” Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma described a new five-pronged approach to combat waste, fraud, and abuse in the Medicare program. The five “pillars” of the initiative are: Stop bad actors. CMS works with the Office of Inspector …
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NY DFS Proposes “Surprise Bill” Amendment
October 15, 2019 | Eric D. Fader | Hospitals | Legislation and Public Policy | Private Insurers
On October 10, the New York State Department of Financial Services released a proposed amendment to the state’s Out-of-Network Law. If approved, the amendment would require insurance companies and healthcare providers to comply with several new requirements to better protect consumers from “surprise” medical bills. Insurers that receive a claim for services rendered by a …
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Proposed Changes to Stark Law Promote Value-Based Provider Arrangements
October 11, 2019 | Benjamin P. Malerba | Ada Kozicz | Fraud and Abuse | Legislation and Public Policy | Medicare and Medicaid
As part of the U.S. Department of Health and Human Services’ “Regulatory Sprint to Coordinated Care,” the U.S. Office of Inspector General (OIG) and the Centers for Medicare and Medicaid Services (CMS) coordinated their efforts in issuing proposed changes to the federal fraud and abuse laws which prohibit certain patient referrals. The changes are intended …
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CMS Updates Medicare Plan Finder Tool
September 24, 2019 | Cassandra Rivais DiNova | Legislation and Public Policy | Medicare and Medicaid | Private Insurers
As Medicare open enrollment approaches, the Centers for Medicare & Medicaid Services (CMS) announced on August 27 the launch of a redesigned Medicare Plan Finder tool. This new tool makes it easier for customers to compare pricing, coverage, and drug plans of Medicare, Medicare Advantage, Medigap, and Part D programs. The Plan Finder tool is …
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OIG Approves Real Estate Transaction With a Medicare-Excluded Individual
September 23, 2019 | Ada Kozicz | Fraud and Abuse | Legislation and Public Policy | Medicare and Medicaid
The U.S. Department of Health and Human Services’ Office of Inspector General (OIG) recently issued a favorable Advisory Opinion (No. 19-05) involving a proposed transaction with an excluded individual. Healthcare entities and providers must always use caution when contemplating proposed transactions with an individual who is excluded from participating in Medicare, Medicaid or other federally …
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Zocdoc Fees Get Anti-Kickback Approval
September 18, 2019 | Eric D. Fader | Fraud and Abuse | Legislation and Public Policy | Medicare and Medicaid
The online appointment booking service Zocdoc has received a favorable Advisory Opinion from the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) confirming that Zocdoc’s new per-click or per-booking fee model does not violate the federal Anti-Kickback Statute (AKS). Without AKS concerns, Zocdoc may now allow Medicare, Medicaid, and other federal …
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Kaiser to Present at PLI Life Sciences Program
September 17, 2019 | Rivkin Rounds Staff | Cybersecurity | Electronic Health Records | FDA | False Claims Act | Fraud and Abuse | Legislation and Public Policy | Litigation | Medical Devices and Wearables | Medicare and Medicaid | Pharmaceuticals | Private Insurers
On October 10, Rivkin Radler’s Jeff Kaiser will be a panelist at the Practising Law Institute (PLI) program, “Life Sciences 2019: Navigating Legal Challenges in the Drug and Device Industries.” Jeff will speak on “Enforcement Trends Impacting the Drug and Device Industries,” including developments under the False Claims Act, federal Anti-Kickback Statute, off-label promotion, and …
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FCA Ruling: Proof of Falsity Needed to Show Fraud
September 16, 2019 | Geoffrey R. Kaiser | False Claims Act | Fraud and Abuse | Hospitals | Legislation and Public Policy | Litigation | Medicare and Medicaid
Last week, the 11th Circuit Court of Appeals handed down its long-awaited decision in United States v. AseraCare, Inc. The case, brought under the False Claims Act (FCA) and argued way back in March 2017, alleged that AseraCare, a for-profit multi-state hospice chain, had submitted false claims to the Medicare program for patients who were …
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