ATTENTION ALCOHOLISM AND SUBSTANCE ABUSE SERVICES PROVIDERS: SAMHSA’s Proposed Changes to 42 CFR Part 2 Address Key Integration Issues, Raise Other Questions About Compliance Responsibilities

In an earlier post, we highlighted that the federal Substance Abuse and Mental Health Services Administration (“SAMHSA”) submitted a proposed rule for public comment in the February 9, 2016 edition of the Federal Register, see 81 FR 6988, proposing a number of changes to 42 CFR Part 2 (“Part 2”), the federal regulations governing the […]

Comptroller Claims NYSDOH Leaves $95 Million of Drug Rebates on the Table

This week, the New York State Comptroller, Thomas P. DiNapoli, issued audit findings which claimed that the New York State Department of Health (“DOH”) failed to capture $95,100,000 in prescription drug rebates it was eligible to receive on drugs administered through the New York State fee-for-service program and the Medicaid Managed Care program from April […]

SCOTUS Grants Cert in King v. Burwell

In what could be very important news this afternoon regarding the Patient Protection and Affordable Care Act (“PPACA,” or more commonly called “Obamacare”), the Supreme Court of the United States announced that it was granting certiorari in the case of King v. Burwell, decided on July 22, 2014, by the United States Court of Appeals […]

Applicability of Fraud and Abuse Rules to the Marketplace Clarified … Somewhat

One of the lingering questions about the Health Insurance Marketplace created under the Affordable Care Act is whether plans on the Marketplace are considered part of a Federal health care program, thus opening up potential liability under the Anti-Kickback Statute. There was concern that the broad language defining a “Federal health care program” would apply […]

OMIG Adopts Regulations Concerning Withholding of Medicaid Payments When Fraud Is Alleged

In accordance with federal law, the OMIG has finalized proposed regulatory changes to conform New York State law to federal law regarding the withholding of payments to Medicaid providers when there is a “credible allegation of fraud.” This requirement is imposed on States that participate in the Medicaid program as part of the the Affordable […]

HHS OIG Identifies $332 Million in Uncollected Medicare Overpayments

On Friday the Office of Inspector General (“OIG”) of the Department of Health and Human Services (“HHS”) made public a report which revealed that the Centers for Medicare and Medicaid Services (“CMS”) had failed to collect over $332 million in Medicare overpayments, for the 30-month period ending March 31, 2009. During that time, OIG had issued […]

Department of Justice & HHS Announce Record Recoveries in 2011

On February 14, 2012, the Department of Health and Human Services (HHS) and the Department of Justice (DOJ) published a Report (a copy of which can be found here) touting recoveries of “[a]pproximately $4.1 billion stolen or otherwise improperly obtained from federal health care programs” in fiscal year 2011. This announcement was accompanied by a […]

CMS Releases Proposed Rules for Reporting and Returning Medicare Overpayments for Parts A and B

The Centers for Medicare & Medicaid Services (CMS) released proposed rules (42 C.F.R. Part 401, Subpart D) for Medicare overpayments to implement section 6402(a) of the Affordable Care Act enacted in 2010.  The Act requires that overpayments be reported and returned to the appropriate Medicare or Medicaid contractor within (60) days from the date the […]

D.C. Circuit Upholds Individual Mandate Provision in PPACA

Today, in a 2-1 split decision, the United States Court of Appeals for the District of Columbia upheld the constitutionality of the individual health care mandate in the Patient Protection in Affordable Care Act. Writing for the majority, Judge Laurence H. Silberman rejected the opponents’ argument that the law exceeded the powers of Congress under the Commerce […]

CMS Publishes Regulations on Accountable Care Organizations

Today, CMS published its final rule implementing the part of the Affordable Care Act governing Accountable Care Organizations (ACOs). A copy of the rule is available here. The portion of the Affordable Care Act implemented under this new rule requires the establishment of the Medicare Shared Savings Program. The Shared Savings Program, in turn, encourages […]