RECENT HEALTH LAW NEWS


Use of the False Claims Act in Health Care Fraud Investigations and Litigation
September 20, 2022 | Rivkin Rounds Staff | False Claims Act | Fraud and Abuse | Litigation | Pharmaceuticals
Rivkin Radler’s Jeff Kaiser will be a panelist at the Upstate New York Health Care Fraud Symposium hosted by the United States Attorney’s Office for the Northern District of New York. Jeff’s panel is entitled “Use of the False Claims Act in Health Care Fraud Investigations and Litigation.” The symposium…
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Pharmacy Owners Charged for Fraud and Kickbacks to a Marketing Company
September 19, 2022 | Ada Janocinska | Uncategorized
The U.S. Department of Justice recently announced that a federal grand jury has charged two pharmacy owners, a mother-daughter duo from South Florida, with healthcare fraud, wire fraud, and payment of kickbacks in exchange for patient referrals. According to the indictment, the pharmacy entered into sham contracts with marketing and…
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NJ Publishes Guidance on Cannabis Sales & Use Tax and Social Equity Excise Fee
September 19, 2022 | Rivkin Rounds Staff | Cannabis | Legislation and Public Policy
The New Jersey Division of Taxation recently provided guidance on registration and licensing requirements, Social Equity Excise Fees, and the Sales & Use tax applicable to companies operating in the cannabis industry. This article by Rivkin Radler’s Louis Vlahos and Timothy Gonzalez summarizes important takeaways from the Division’s publication. Sign…
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Dental Care Alliance Settles Cyberattack Lawsuit for $3 Million
September 07, 2022 | Mary Connolly | Cybersecurity | Dentistry | Electronic Health Records | Litigation
Dental Care Alliance, LLC (DCA) agreed to settle a class action lawsuit that arose out of a 2020 cyberattack. A hearing to approve the $3 million settlement was held on September 1. DCA, based in Sarasota, Fla., is a dental services organization that provides practice support to over 390 affiliated…
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Dermatology Practice Settles Alleged HIPAA Violations
September 02, 2022 | Mary Connolly | HIPAA | Litigation
On August 23, the U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) announced that Massachusetts-based New England Dermatology, P.C., d/b/a New England Dermatology and Laser Center (NEDLC), agreed to resolve alleged HIPAA violations for a fine of $300,640. OCR commenced an investigation of NEDLC after the…
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As Telemedicine Expands, Insurance Fraud Grows
September 02, 2022 | Rivkin Rounds Staff | Fraud and Abuse | Litigation | Medicare and Medicaid | Telehealth
Rivkin Radler’s Michael Sirignano authored an article for the September 2 issue of the New York Law Journal entitled “As Telemedicine Expands, Insurance Fraud Grows.” The article discussed recent enforcement actions by the U.S. Department of Justice and the recent Special Fraud Alert issued by the U.S. Department of Health…
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Conducting HIPAA Breach Assessments and Disclosures: Requirements and Tips for Success
September 01, 2022 | Rivkin Rounds Staff | Cybersecurity | Electronic Health Records | HIPAA | Legislation and Public Policy
In the next installment of Rivkin Radler’s Healthcare Compliance Lunch & Learn series, Ashley Algazi will discuss requirements and tips for success in conducting HIPAA breach assessments and making required disclosures. The program will: • Review HIPAA breach definition • Discuss the analysis and investigation process to determine whether a…
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Fraud Week: Optical Lens Maker Reaches Kickback Settlement
August 27, 2022 | Eric Fader | False Claims Act | Fraud and Abuse | Legislation and Public Policy | Medicare and Medicaid
On August 23, the U.S. Department of Justice announced that Dallas-based optical lens manufacturer Essilor International and its affiliates agreed to pay $16.4 million to settle alleged violations of the federal Anti-Kickback Statute (AKS). Three former Essilor district sales managers filed a whistleblower suit under the False Claims Act claiming…
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Fraud Week: More Non-Existent Services
August 25, 2022 | Eric Fader | Fraud and Abuse | Litigation | Medical Devices and Wearables | Medicare and Medicaid | Private Insurers
If our most recent Fraud Week post (NY Chiropractor Billed for Non-Existent Acupuncture Services) didn’t already drive home the point, it is worth emphasizing that billing insurers for items or services that weren’t actually provided is always a bad idea. On August 4, the U.S. Department of Justice (DOJ) announced…
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OIG Concludes that $25 Patient Gift Card Presents Low Risk of Fraud and Abuse
August 24, 2022 | Ada Janocinska | 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 an Advisory Opinion on offering gift cards to patients for completing an online patient education program. In this particular case, the online program was used to educate patients on the risks, benefits and expectations relating…
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Fraud Week: NY Chiropractor Billed for Non-Existent Acupuncture Services
August 23, 2022 | Eric Fader | Fraud and Abuse | Litigation | Private Insurers
On August 15, the U.S. Department of Justice (DOJ) announced that a Long Island chiropractor pleaded guilty to healthcare fraud for billing a private insurance company over $1 million for acupuncture services that were never performed. The investigation of Peter Adamczak was a joint effort by DOJ, the New York…
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Fraud Week: Unlucky Pharmacist
August 23, 2022 | Eric Fader | Fraud and Abuse | Litigation | Medicare and Medicaid | Pharmaceuticals | Telehealth
Rivkin Rounds’ first Fraud Week kicks off with kickbacks. The U.S. Department of Justice (DOJ) recently announced that the owner of Boerne Drug in Boerne, Texas was indicted on conspiracy charges for his role in an alleged kickback scheme. According to DOJ, pharmacy owner Lucky S. Ott and his co-conspirators…
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Employer Alert: First Deadline to Claim NYS Healthcare Worker Bonus is September 2
August 17, 2022 | Ada Janocinska | Behavioral Health | COVID-19 | Employer/Employee | Hospitals | Legislation and Public Policy | Medicare and Medicaid | Nursing Homes
As part of its 2023 state budget, New York State has allocated $1.2 billion for the payment of bonuses to certain frontline healthcare workers. This bonus program is intended to reward healthcare workers for their services during the COVID-19 pandemic and to promote employee retention and recruitment in the healthcare…
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Kaiser to be PLI Panelist on Drug and Device Enforcement Trends
August 12, 2022 | Rivkin Rounds Staff | False Claims Act | Fraud and Abuse | Legislation and Public Policy | Litigation | Medical Devices and Wearables | Medicare and Medicaid | Pharmaceuticals
On September 28, Rivkin Radler’s Jeff Kaiser will be a panelist at the Practising Law Institute’s program, Life Sciences 2022: Navigating Legal Challenges in Drug and Device Industries. The program is designed for attorneys and allied professionals who counsel pharmaceutical and life sciences companies. Entitled “Enforcement Trends Impacting the Drug…
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Private Insurers Must Watch Out for Medical Equipment Fraud
August 11, 2022 | Rivkin Rounds Staff | Fraud and Abuse | Litigation | Medical Devices and Wearables | Medicare and Medicaid | Private Insurers
Healthcare fraud related to durable medical equipment (DME) is extremely costly to insurers, yet often continues without criminal or civil consequences. Rivkin Radler’s Michael Vanunu recently wrote an article on the topic for Law360. Sign up to receive Rivkin Rounds at www.RivkinRounds.com. Continue Reading
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NY Medical Practice Settles False Claims Act Allegations Related to “Incident-To” Billing
August 08, 2022 | Mary Connolly | False Claims Act | Fraud and Abuse | Litigation | Medicare and Medicaid
On August 3, North Country Neurology, P.C., a physician-owned medical practice located in Watertown, NY (the “Practice”), reached a settlement with the U.S. Attorney’s Office for the Northern District of New York to pay $850,000 for submitting false Medicare claims for payment. Among other things, the Practice admitted to having…
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Spinal Device Distributor, Owners and PODs Settle Kickback Claims for $1 Million
July 27, 2022 | Eric Fader | False Claims Act | Fraud and Abuse | Litigation | Medical Devices and Wearables | Medicare and Medicaid
The U.S. Department of Justice (DOJ) recently announced that Reliance Medical Systems LLC, a Utah-based distributor of spinal implant devices, two of its individual owners, and two of its physician-owned distributorships (PODs) agreed to pay $1 million to resolve a lawsuit brought under the False Claims Act. Reliance allegedly operated…
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HHS OIG Issues Telehealth Fraud Alert
July 26, 2022 | Eric Fader | Fraud and Abuse | Litigation | Medicare and Medicaid | Telehealth
On July 20, the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) issued a Special Fraud Alert to caution healthcare practitioners who may wish to enter into arrangements with telehealth companies. The Alert describes several types of fraud schemes that have resulted in federal investigations and…
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Amazon to Acquire One Medical for $3.9 Billion
July 22, 2022 | Rivkin Rounds Staff | Telehealth | Uncategorized
On July 21, Amazon confirmed that it intends to acquire One Medical for approximately $3.9 billion in an all-cash transaction. One Medical is a membership-based, technology-driven, primary care and telehealth organization with about 767,000 members as of the end of March 2022. The deal strengthens Amazon’s growing connections to the…
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HHS Renews COVID-19 Public Health Emergency Again
July 21, 2022 | Eric Fader | COVID-19 | Legislation and Public Policy | Medicare and Medicaid | Telehealth
On July 15, U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra formally extended the COVID-19 public health emergency for another 90 days. The PHE, which originally went into effect in January 2020, provides important flexibilities for healthcare providers, including expanding the types of telehealth services that are…
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University Health Center Pays $875,000 in HIPAA Fines after Cyber Hack
July 19, 2022 | Ada Janocinska | Cybersecurity | Electronic Health Records | HIPAA | Litigation
Oklahoma State University’s Center for Health Services recently paid $875,000 to settle potential HIPAA violations after a cyberattack resulted in the unauthorized access of its patients’ protected health information. A hacker installed malware on the Center’s web server which contained electronic protected health information. More than 275,000 individuals were affected…
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Transparency in Coverage Final Rule Took Effect on July 1
July 18, 2022 | Mary Connolly | Affordable Care Act | Legislation and Public Policy | Pharmaceuticals | Private Insurers
The Centers for Medicare & Medicaid Services’ Transparency in Coverage Final Rule took effect on July 1, following a six-month delay in implementation to allow payers to come into compliance. The Final Rule requires group health plans and health insurance issuers offering non-grandfathered coverage in the group and individual markets…
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New OMIG Compliance Regulations: What You Need to Know
July 13, 2022 | Rivkin Rounds Staff | Fraud and Abuse | Legislation and Public Policy | Medicare and Medicaid
On July 13, the New York Office of Medicaid Inspector General (OMIG) published proposed regulations implementing 2020 changes to law relating to provider compliance programs, Medicaid managed care fraud, waste and abuse prevention programs, and OMIG’s self-disclosure program. The proposed changes will significantly affect both payers and providers alike. In…
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The Anti-Kickback Statute’s Role in Health Insurance Fraud Cases
July 08, 2022 | Rivkin Rounds Staff | False Claims Act | Fraud and Abuse | Hospitals | Litigation | Medicare and Medicaid | Pharmaceuticals
Rivkin Radler’s Michael Sirignano authored a recent article for the New York Law Journal entitled “The Anti-Kickback Statute’s Role in Health Insurance Fraud Cases.” The article discussed recent lawsuits against physicians, laboratories, hospitals, and a large pharmaceutical company, McKesson Corporation, under the False Claims Act and federal Anti-Kickback Statute. Continue…
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California Corporate Practice of Medicine Lawsuit Survives Motion to Dismiss
June 28, 2022 | Eric Fader | Fraud and Abuse | Legislation and Public Policy | Litigation
On May 27, the U.S. District Court for the Northern District of California refused to dismiss a lawsuit[1] brought against Envision Healthcare Corp. alleging violations of California’s corporate practice of medicine (CPOM) prohibition, as well as state fee-splitting and kickback prohibitions. The action was brought by the American Academy of…
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HHS Issues Guidance on Provider Use of Audio-Only Telehealth
June 17, 2022 | Mary Connolly | COVID-19 | HIPAA | Legislation and Public Policy | Telehealth
On June 13, the U.S. Department of Health and Human Services (HHS) issued guidance to explain how audio-only telehealth can comply with HIPAA, while also emphasizing that this mode of telehealth services can expand healthcare access to individuals who may have limited internet and broadband capabilities. In response to the…
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NYSDA Dental Hygiene Bill Signed into Law
June 08, 2022 | Rivkin Rounds Staff | Dentistry | Legislation and Public Policy
On May 9, New York Gov. Kathy Hochul signed into law a dental hygiene bill that allows dental hygienists to use nitrous oxide and local infiltration anesthesia to assist dentists with all dental procedures. The bill, which was originally introduced in the State Senate in May 2021, amends section 6605-b…
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Addressing Patient Capacity Issues
June 03, 2022 | Rivkin Rounds Staff | Behavioral Health | HIPAA | Hospitals | Nursing Homes
On Thursday, June 16, in the next installment of Rivkin Radler’s Healthcare Lunch & Learn series, firm partners Frank Izzo and Wendy Sheinberg will present a program on Addressing Patient Capacity Issues. The program will take place from 12:00 noon to 1:00 PM Eastern time via Zoom. The topics to…
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OIG Permits Arrangement Involving Physician-Owned Medical Device Company
June 02, 2022 | Mary Connolly | Fraud and Abuse | Hospitals | Legislation and Public Policy | Medical Devices and Wearables | Medicare and Medicaid
In a recent Advisory Opinion, the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) determined that an arrangement involving certain physicians who have an ownership interest in a medical device company that manufactures products that may be ordered by the physician owners (the “Company”) was not…
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Transitioning to a DSO: An Emerging Trend in Orthodontic Practice Transitions
May 31, 2022 | Rivkin Rounds Staff | Dentistry
Over the last several years, the dental services industry has become increasingly consolidated, creating significant financial opportunities for investors as well as financial and exit opportunities for dentists. This consolidation has been driven in large part by Dental Services Organizations (DSOs) formed by dentists and/or private financial investors (e.g., private…
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New NY Agency Established to Oversee PBMs
May 25, 2022 | Mary Connolly | Legislation and Public Policy | Medicare and Medicaid | Pharmaceuticals | Private Insurers
On May 11, New York Gov. Kathy Hochul announced the establishment of the Pharmacy Benefits Bureau within the State’s Department of Financial Services (DFS). The Bureau will handle the licensing and supervision of pharmacy benefit managers (PBMs), and in particular their impact on consumers and the cost of healthcare. The…
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Did Your Practice Get Burned Online? Reach Out — and Redirect
May 23, 2022 | Rivkin Rounds Staff | HIPAA
An article published on May 16 in Part B News, “Did your practice get burned online? Reach out — and redirect,” discussed how (or whether) professional practices should respond to negative reviews online from patients. Rivkin Radler’s Eric Fader was quoted in the article. Eric said that he advised one of…
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Prepare and Monitor: Take Extra Steps when the Patient’s a Medical Tourist
May 20, 2022 | Rivkin Rounds Staff | COVID-19 | Litigation | Uncategorized
An article published on May 16 in Part B News, “Prepare and monitor: Take extra steps when the patient’s a medical tourist,” discussed issues that U.S. medical practices can face when a patient receives medical treatment abroad. The medical tourism industry has been growing rapidly, led by a demand for…
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OIG: Biopharma Company’s Provision of Free Genetic Tests Does Not Warrant Sanctions Under AKS
May 17, 2022 | Jeffrey Ehrhardt and Jeff Kaiser | Fraud and Abuse | Legislation and Public Policy | Medicare and Medicaid | Pharmaceuticals
With the proliferation of precision and individualized medicine, genetic testing and counseling will likely remain on the radar of the Department of Health and Human Services’ Office of Inspector General (OIG) and the Department of Justice for years to come. Biopharma companies and manufacturers must carefully consider the facts and…
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Mental Health Parity – After Years of Failure to Comply, Enforcement is Underway!
May 13, 2022 | Chris Kutner | Behavioral Health | Legislation and Public Policy | Medicare and Medicaid | Private Insurers
Regulators are now better armed to cite and fine health plans that are not complying with the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008. A recent report to Congress highlights the enforcement work to date and illustrates the extent to which many plans are noncompliant with the law.…
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OIG Issues Favorable Opinion for Providing Free Smartphones to Patients to Promote Telehealth Services
May 10, 2022 | Ada Janocinska | COVID-19 | Fraud and Abuse | Legislation and Public Policy | Medicare and Medicaid | Telehealth
The increased use of telehealth services is a trend that is expected to continue long after the COVID-19 pandemic ends. In keeping with this trend, the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) recently issued a favorable Advisory Opinion that allowed a federally qualified health…
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NY Pharmacy Owner Sentenced for Healthcare Fraud
May 09, 2022 | Eric Fader | Fraud and Abuse | Litigation | Medicare and Medicaid | Pharmaceuticals
A New York woman was sentenced last month to 78 months in prison for defrauding healthcare programs, including obtaining more than $6.5 million from Medicare Part D plans and Medicaid drug plans. Queens resident Aleah Mohammed owned five pharmacies, four of which operated under variations of the name “Superdrugs.” Between…
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21 Charged in Federal COVID-19 Fraud Sweep
April 27, 2022 | Eric Fader | COVID-19 | Fraud and Abuse | Litigation | Medicare and Medicaid | Telehealth
On April 20, the U.S. Department of Justice (DOJ) announced criminal charges against 21 people across the country for COVID-19-related frauds. The defendants are accused of over $149 million in false billings to federal programs and thefts from federally funded pandemic assistance programs. Some of the defendants, in California, New…
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NYS Budget Aims to Keep Network of CDPAP Fiscal Intermediaries Intact
April 19, 2022 | Mary Connolly | Home Health | Legislation and Public Policy | Medicare and Medicaid
In December 2019, the New York State Department of Health (DOH) issued a Request for Offers (RFO) from fiscal intermediaries (FIs) to enter into contracts with the DOH to provide FI services in the Consumer Directed Personal Assistance Program (CDPAP) for persons enrolled in Medicaid fee-for-service and Medicaid managed care…
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FTC Appears Ready to Begin Enforcing Its Health Breach Notification Rule
April 19, 2022 | Rivkin Rounds Staff | Cybersecurity | Electronic Health Records | Legislation and Public Policy | Medical Devices and Wearables
Rivkin Radler’s Shari Claire Lewis wrote an article, “FTC Appears Ready to Begin Enforcing Its Health Breach Notification Rule,” that was published in the New York Law Journal on April 18. The article discusses the Federal Trade Commission’s rule that requires manufacturers of connected medical devices, fitness trackers and other…
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HHS Extends COVID-19 Public Health Emergency Again
April 15, 2022 | Eric Fader | COVID-19 | Legislation and Public Policy | Medicare and Medicaid | Telehealth
On April 12, Department of Health and Human Services (HHS) Secretary Xavier Becerra extended the COVID-19 public health emergency for another 90 days. The PHE had been scheduled to expire on April 16. The PHE originally went into effect in January 2020, at the onset of the pandemic. It provides…
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New Law Allows Experienced NPs to Practice Independently in NY
April 13, 2022 | Jeffrey Ehrhardt and Eric Fader | Legislation and Public Policy
New York’s 2023 state budget, signed into law on April 9, included an amendment to the state’s Education Law establishing 3,600 practice hours as a threshold beyond which nurse practitioners no longer require a collaborative agreement or a collaborative relationship with a physician to practice within their educational and clinical…
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DOJ Intervenes in Kickback Lawsuit Against Lab and Hospital Execs
April 11, 2022 | Mary Connolly | False Claims Act | Fraud and Abuse | Hospitals | Litigation | Medicare and Medicaid
The U.S. Department of Justice (DOJ) recently intervened in an action filed in Texas against two laboratory CEOs, one hospital CEO, and numerous other executives, employees, and recruiters, seeking civil penalties and treble damages for violations of the False Claims Act. The DOJ’s complaint, which was unsealed on April 4,…
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HHS Issues Guidance Clarifying Obligations of HIPAA Covered Entities
April 08, 2022 | Mary Connolly | Electronic Health Records | HIPAA | Legislation and Public Policy
On March 22, the U.S. Department of Health and Human Services (HHS) issued guidance clarifying the obligations of covered entities to require their business associates to comply with HIPAA Administrative Simplification requirements related to standards for electronic health care transactions, code sets, unique identifiers, and operating rules. While these requirements…
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ACO REACH Tweaks Help Smaller Group Practices, Promote Health Equity
April 06, 2022 | Rivkin Rounds Staff | ACOs | Legislation and Public Policy | Medicare and Medicaid
A March 21 article in Part B News, ACO REACH tweaks help smaller group practices, promote health equity,” discussed the Accountable Care Organization (ACO) Realizing Equity, Access and Community Health (REACH) model, which was announced on February 24 as a replacement for the CMS Global and Professional Direct Contracting (GPDC)…
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