For legal professionals across the globe, it’s imperative to stay updated with recent developments in legal news. One such noteworthy announcement is the suspension of the arbitration process for “Surprise Billing” put in place by the “No Surprises Act”. This marks the second time the Centers for Medicare & Medicaid Services (CMS) has opted to…
On August 3, 2023, in a move favoring the Texas Medical Association, the United States District Court for the Eastern District of Texas made a significant judgment. This judgment involved vacating certain key aspects of the guidance related to the administrative fee for the Independent Dispute Resolution (IDR) process established by the No Surprises Act….
The Healthcare Privacy Compliance Academy, organized by the Health Care Compliance Association (HCCA), will be held from October 16th to 19th, in San Francisco, California. The entire program is devised with practitioners who already have a base knowledge of compliance in mind, underlining the advanced level of the discussion and teachings offered. The Academy promises…
July 2023 marked a period of heightened enforcement activity for the Health and Human Services (HHS) Office of Inspector General. Legal professionals, particularly those working with corporations and law firms closely entwined with the healthcare industry, would want to follow these recent developments closely. The comprehensive shifts in the enforcement guidelines affect various elements of…
On July 31, 2023, the Centers for Medicare & Medicaid Services (CMS) announced its final rule under the Skilled Nursing Facility Prospective Payment System (SNF PPS) for fiscal year 2024. The update included new rates and payment policies for this sector. The 2024 Final Rule is not limited to amendments in the payment rates, but…
AstraZeneca’s cancer drug Calquence, has weathered a significant challenge by dodging a review by the Patent and Trial Appeal Board (PTAB). Calquence, a pharmaceutical drug that has accounted for more than $2 billion in sales for AstraZeneca the previous year, is clearly a high-valued asset for the international pharmaceutical company. The legal confrontation had commenced…
In Florida, a pediatric therapy clinic has been awarded almost $5.2 million in damages following a noncompete lawsuit. This outcome was the result of a bench trial after the judge found two employees guilty of an intentionally constructed scheme to redirect patients and a massive amount of money to their own businesses. The verdict came…
As August 2023 unfolds, we are witnessing an increasing trend on state grounds where law makers have introduced changes to healthcare regulations. Notably, Montana has passed a new law giving comprehensive legal protection to healthcare practitioners who, due to their ethical, moral, or religious beliefs, refuse to prescribe marijuana, participate in procedures such as abortion,…
The Centers for Medicare & Medicaid Services (CMS) recently stated in a newly released MedLearn Matter (MLN7867599, July 2023) that from July 13, 2021 onwards, any “new hospice agency” situated in the states of Texas, California, Arizona, and Nevada will be subjected to a “provisional period of enhanced oversight” for up to a year. The…
The Centers for Medicare & Medicaid Services (CMS) has recently announced the launch of a new primary care model, known as Making Care Primary (MCP). This model is particularly designed for smaller, independent primary care practices and organizations that have expressed interest in independent participation in value-based care initiatives. According to the announcement on JDSupra.com,…
Last week delivered a significant twist in the ongoing legal saga surrounding the No Surprises Act (NSA). After a considerable period of quiet months, a Texas district court issued a crucial decision — a move instigated primarily by the Texas Medical Association among an array of other healthcare providers. These bodies have repeatedly challenged the…
On August 1, 2023, the Centers for Medicare & Medicaid Services (CMS) announced the annual Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) Final Rule for the Fiscal Year (FY) 2024, setting a new direction for payment systems within the healthcare sector. The final rule addresses several pivotal…
On June 27, 2023, Connecticut legislation took a significant stride in expanding nursing rights, which has shown a potential shift in how hospitals plan their staffing. Connecticut Governor Ned Lamont signed into law Public Act 23-204, “An Act Concerning the State Budget for the Biennium Ending June 30, 2025, and Making Appropriations Therefor, and Provisions…
On August 1, 2023, the United States Citizenship and Immigration Services (USCIS) announced the results of the second H-1B visa lottery, selecting a significant number of additional H-1B cap registrations to reach the annual quota of 85,000. This second lottery included an additional 77,400 selections by the USCIS, bringing the total number this year to…
On the 31st of July, 2023, the California Office of Health Care Affordability (OHCA) publicized draft regulations regarding the pre-transaction scrutiny of what is termed as “Material Change Transactions.” These regulations form an integral part of its legislative authority to examine transactions that could potentially influence the costs of health care in the State of…
The No Surprises Act (NSA) was enacted by Congress in 2020 with an intention to minimize surprising medical bills and to facilitate a swift and straightforward procedure for out-of-network healthcare providers to receive payment from insurers. Despite this, the U.S. Department of Health and Human Services (HHS) and other agencies created regulations to regulate this…
In a much-anticipated move, the Centers for Medicare and Medicaid Services (CMS) released its final guidance for the Medicare Drug Price Negotiation Program through the Inflation Reduction Act (IRA) on June 30, 2023. MoFo Life Sciences reports. It is an unprecedented initiative aimed at lowering healthcare costs for millions of Americans. The strategy mandates that…
On August 1, 2023, The U.S. Food & Drug Administration (FDA) and the Drug Enforcement Administration (DEA) made a collective call to address the ongoing shortage of prescription stimulants in a joint letter addressed to the American public. As professionals in the legal field, this development touches especially on those of us working with pharmaceutical…
On July 13, 2023, the Centers for Medicare & Medicaid Services (CMS) unveiled a proposal intended to considerably broaden behavioral health coverage provided under Medicare. This announcement was made as a part of the calendar year 2024 Medicare Physician Fee Schedule (PFS). The proposed changes might lead to a significant amplification in the range of…
In recent years, the increasing use of data analytics in identifying fraudulent conduct within the healthcare sector has been a notable topic of interest in the legal world. Law enforcement authorities, federal agencies, and private whistleblowers are working in sync with data science practitioners to analyze extensive data sets, thereby bringing to light fraudulent practices….
In a recent ruling on August 3, the U.S. District Court for the Eastern District of Texas dealt a significant blow to the regulations governing the arbitration process established by the No Surprises Act (NSA). As prescribed by the NSA, these regulations were put in place to orchestrate payment disputes between out-of-network healthcare providers and…
In the continually evolving environment of healthcare, there is a critical aspect rarely understood by even seasoned legal professionals – exclusion screening. Routine screening checks are compulsory in the healthcare sector. Still, the importance of exclusion screening trumps most compliance audits, especially concerning federally funded health care programs. The Office of the Inspector General (OIG)…
The country’s three largest for-profit health systems – HCA Healthcare, Tenet Healthcare and Community Health Systems (CHS) – all posted their second quarter earnings recently. Whilst HCA and Tenet reported net incomes for the quarter, CHS posted a net loss. Nevertheless, all three health systems found themselves in a significantly healthier financial position in Q2…
As an increasing concern in today’s digital age, data security breaches continue to pose major threats to corporations worldwide. The most recent casualty is Mutual of Omaha Rx, a subsidiary of Omaha Health Insurance Company (“OHIC”), itself a division of Mutual of Omaha. OHIC reported a data breach involving sensitive member information to the Attorney…
As legal professionals operating in the health care sector, there are essential regulatory developments in California that demand your attention. The California Office of Health Care Affordability (OHCA) under its proposed regulations is scheduled to launch an advanced regulatory review of specific healthcare transactions, effective January 1, 2024. Transactions such as mergers, acquisitions, affiliations, or…