On Wednesday, the Centers for Medicare and Medicaid Services (“CMS”) issued a second round of long-awaited red tape reduction initiatives aimed at ameliorating overly burdensome provider regulations. The changes, memorialized within a Final Rule scheduled for publication on May 12, 2014 (available for review here: http://federalregister.gov/a/2014-10687) (“Unpublished Final Rule”) include significant easing of Conditions of … Continue Reading
In the September 2013 edition of the Cleveland Bar Journal, Colin Jennings and Tom Zeno described the government’s determination to challenge medical decision making as medically not necessary. To read the article, visit Uncle Sam Becomes a Doctor: Government Challenges to Medical Necessity. Recent prosecutions have been born out of their prediction. In October 2013, … Continue Reading
Yesterday, Amgen received approval of a global settlement from the federal judge in New York presiding over the criminal case filed against Amgen by the Department of Justice regarding the off-label promotion of the anemia drug Aranesp. The settlement resolves criminal charges and civil kickback claims filed by the federal government, claims of Medicaid fraud filed by 49 states … Continue Reading
Yesterday, the federal government announced that the federal government will not provide 100% funding for states that do not participate in the full Medicaid expansion contained in PPACA, as described by the Washington Post. Partial expansions will be permitted but will only receive matching federal money at the existing rate, at least for 2014-2017. As we … Continue Reading
As part of its Work Plan for Fiscal Year 2013, the Office of Inspector General (“OIG”) plans to focus on the following current and new issues in the Medicaid program: prescription drugs; home, community, and personal care services; equipment and supplies; state management and oversight; the Children’s Health Insurance Program; Medicaid data systems, controls, and … Continue Reading
The decision we’ve all been waiting for is in — the U.S. Supreme Court has ruled that the statute commonly known as the individual insurance mandate (everyone must have minimum health insurance coverage or pay a penalty) is constitutional under Congress’ taxing power. Because the individual mandate was upheld, the rest of the Affordable Care Act (“PPACA”) has also survived. The … Continue Reading
The U.S. Supreme Court has completed announcing its decisions for today, and still no decision on PPACA (Department of Health and Human Servs. v. Florida (No.11-398) and National Federation of Independent Business v. Sebelius (No. 11-393)). The Court is sitting again on Thursday and will likely announce decisions in the remaining cases from this term … Continue Reading
It appears that the National Medicaid Audit Program hasn’t been worth the money it cost to run. According to published testimony released by the Government Accountability Office (GAO) today, only 4% of the 1,550 audits, though, resulted in refunds to the government of approximately $7.4 million. More than two-thirds of the audits found no overpayments. The remaining 27% … Continue Reading
Next week, the drama begins — the Supreme Court will hold what promises to be the biggest (an impressive 6 hours) and most important series of oral arguments of the decade, if not the century — to decide the future of Obama’s health care reform, PPACA. The government will be primarily represented by Solicitor General Don Verilli; arguing most … Continue Reading
Last week, Ohio Governor John Kasich announced his proposal to balance Ohio’s budget (the Blue Book). Because the Ohio budget is in large part reserved for Medicaid, health care changes play a significant role in the new budget plan. The slides below are from a presentation summarizing Kasich’s budget plan. The plan is merely an … Continue Reading
