On April 11, 2016, the Centers for Medicare and Medicaid Services (CMS) announced its Comprehensive Primary Care Plus (CPC+) initiative. Part of CMS’ attempt to shift Medicare from its traditional fee-for-service model to a value-based care model, CPC+ is CMS’ largest attempt so far to transform the way primary care is provided and reimbursed.
Health Care Delivery System Reform
The Centers for Medicare and Medicaid Services (CMS) intends to strengthen provider and supplier enrollment screening – meaning, scrutinize providers and suppliers more closely during enrollment – according to a February 22, 2016 post on its blog, The CMS Blog.
On Friday, February 12, 2016, the Centers for Medicare and Medicaid Services (CMS) released the long-awaited Final Rule and regulations, providing much needed guidance to providers and suppliers on how to meet the Affordable Care Act’s (ACA’s) 60-day overpayment mandate. Specifically, a provision enacted as part of the ACA in 2010 requires that all Medicare and Medicaid overp
I was amused after reading the California Court of Appeal opinion in the case of Unilab Corporation v. Angeles-IPA. The legal issues in the case are fairly straight forward and unremarkable. However, the court’s description of the facts of this case are of interest, as they reveal some of the complexity in the delivery of, and payment for, health care services. In this situation, testing by a commercial laboratory of specimens drawn at a physician’s office.
Earlier this week, BNA’s Health Care Daily Report picked up on the announcement of a settlement in two False Claims Act cases. (United States ex rel. Odumosu v. Pediatric Servs. of Am. Healthcare, N.D. Ga., No. 1:11-cv-1007; United States ex rel. McCray v. Pediatric Servs. of Am., S.D. Ga., No.
On Monday, a federal district court judge in New York issued a ruling that, if adopted broadly, will have a significant – and potentially nightmarish – impact on any provider who receives an overpayment from Medicare or Medicaid. Kane v. Healthfirst, Inc. and U.S. v.
King v. Burwell understandably took the attention of the health care industry a couple of weeks ago when it upheld a key component of the Affordable Care Act. A day later, however, the Supreme Court released another decision that may have a more significant going-forward impact on the health care industry: the Obergefell decision, which declares that gay individuals have a right under the 14th Amendment and Equal Protection Clause of the U.S.
In the long awaited decision in King v. Burwell, the Supreme Court ruled this morning in a 6-to-3 decision that the Affordable Care Act (ACA) permits tax credits for individuals who purchase their health insurance through a Federal health insurance marketplace (Federal Exchange), not just for individuals who purchase through State-operated marketplaces.
On June 9, 2015, the Centers for Medicare and Medicaid Services (CMS) published a final rule in the Federal Register making changes to the Medicare Shared Savings Program for Accountable Care Organizations (ACOs). These changes were intended to encourage increased participation by hospitals, rural health centers, federally qualified health centers, physicians, and other eligible health care providers in the Shared Savings Program
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