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

A New York anesthesiologist was indicted on July 9 for conspiring with pharmacies and medical equipment suppliers to defraud the Medicare program and other insurers. Anna Steiner, also known as Hanna Wasielewska, allegedly wrote prescriptions for drugs and durable medical equipment for patients supposedly seen via telemedicine without ever having actually examined or evaluated the

A new federal regulation that would have required companies to disclose wholesale prices of prescription drugs in television advertisements was rejected by a federal court on July 8, one day before the rule would have taken effect. Amgen Inc., Eli Lilly & Co. and Merck & Co. Inc. had filed suit challenging the rule, claiming

The Centers for Medicare & Medicaid Services (CMS) expects to release proposed revisions to the federal physician self-referral prohibition (Stark Law) before Labor Day, according to Kim Brandt, CMS’s principal deputy administrator for operations. Brandt was speaking at an industry conference. Potential Stark Law changes were recently discussed here.

CMS had requested input from the

Three of the largest pharmaceutical companies in the U.S. filed suit on June 14 against the U.S. Department of Health and Human Services (HHS), claiming that HHS doesn’t have the power to compel companies to include list prices of prescription drugs in television advertisements. HHS’s new rule is set to take effect on July 9.

On June 6, the Center for Medicare & Medicaid Services (CMS) issued a Request for Information (RFI) regarding its Patients over Paperwork Initiative. CMS is seeking public input on ways to reduce administrative and regulatory burdens on healthcare providers, with an overall goal of reducing healthcare costs and increasing the time providers spend with their

In a 7-1 decision, the U.S. Supreme Court ruled on June 3 that the Department of Health and Human Services (HHS) may not adjust the rates it pays hospitals for serving low-income patients without first giving them an opportunity to comment on the changes. The Medicare Act requires public notice and a 60-day comment period

On May 28, the Centers for Medicare and Medicaid Services (CMS) issued a final rule to improve and modernize the Programs of All-Inclusive Care for the Elderly (PACE). The rule is the first major change to the program since 2006. CMS expects that the changes will help incorporate current best practices in the care rendered

On May 8, the U.S. Department of Health and Human Services announced a final rule from the Centers for Medicare & Medicaid Services requiring pharmaceutical companies to disclose the list prices of prescription drugs in television advertisements. The rule will apply to all drugs covered by Medicare or Medicaid that cost at least $35 per

An April 30 article in Managed Care, “Centene, big in Medicaid managed care, wants to get even bigger,” discussed the business plans of Centene, the largest Medicaid managed care insurer in the U.S.  Rivkin Radler’s Christopher J. Kutner was quoted in the article.

Centene is hoping that its proposed acquisition of WellCare Health Plans will