HHS Releases Proposed Rule for Health Insurance Exchange Regulations

On July 11, 2011, the U.S. Department of Health and Human Services (“HHS”) issued a proposed rule that would implement Affordable Insurance Exchanges, pursuant to the Patient Protection and Affordable Care Act (“PPACA”).  Exchanges are, in essence, state-based insurance marketplaces that combine insurance risks together with insurance premiums.  Exchanges are set to be operational and […]

Gov. Cuomo Submits Health Benefit Exchange Bill to Rival NY Senate Majority Bill

New York State Governor Andrew Cuomo submitted a Governor’s program bill yesterday, June 13, 2011, proposing legislation that would comply with the requirements of the Federal Patient Protection and Affordable Care Act (PPACA) to create a Health Benefit Exchange.  The exchange, once established, will be a statewide “marketplace” through which individuals and small business who do not have […]

CMS Proposes Rule to Make Medicare Data Available for Public Reports About Providers

The Patient Protection and Affordable Care Act (“PPACA”) requires that “standardized extracts” of Medicare claims data be made available to “qualified entities” in connection with their preparation of reports evaluating the performance of providers.  Since this information is now “required by law,” these disclosures are allowed under the Health Insurance Portability and Accountability Act’s Privacy […]

CMS Releases Exceptions to ACO Rules for Rural Areas

The Centers for Medicare & Medicaid Services (CMS) has released a fact sheet titled “Medicare Shared Savings Program and Rural Providers” highlighting exceptions to the proposed regulations governing accountable care organizations (ACOs). On March 31, 2011, CMS released its proposed rules for ACOs. According to CMS, ACOs are supposed to help doctors, hospitals and health […]

US Supreme Court Rules in FCA, FOIA Case

On May 16, 2011 the US Supreme Court resolved a split among federal circuits and ruled in Schindler Elevator Corp. v. United States ex rel. Kirk that a federal agency’s response to a Freedom of Information Act (FOIA) request amounts to a “report” within the False Claims Act’s (FCA) pre-PPACA public disclosure bar and therefore […]

Supreme Court Rejects Virginia’s Request to Fast Track Challenge to PPACA

Yesterday, the United States Supreme Court rejected a request made by the Commonwealth of Virginia to fast track a challenge to the Patient Protection and Affordable Care Act (PPACA) passed last year. When a case is fast-tracked, it bypasses the regular federal appeals process, and the case goes directly to the Supreme Court Justices for review.  […]

OIG Finds Various State’s False Claims Acts, Including New York’s, To Be Noncompliant

The term “qui tam” comes from the latin phrase qui tam pro domino rege quam pro se ipso in hac parte sequitur, which means “[he] who sues in this matter for the king as [well as] for himself.”  In our legal system, qui tam actions are brought by private individuals, or whistleblowers, with knowledge of […]

Senate Passes 1099 Reporting Repeal; Shortfall to Be Addressed by Repayment of Health Care Insurance Tax Credit

On Tuesday, the United States Senate voted 87–12 to repeal a controversial tax-reporting measure included in last year’s healthcare law, which would have required businesses that made payments in excess of $600 to vendors to file a 1099 form in each instance.  The news will undoubtedly be well-received by businesses, which had argued that the […]

CMS Proposes Rules for New ACOs

On March 31, 2011, the Centers for Medicare & Medicaid Services (CMS) proposed much-anticipated rules under the Patient Protection and Affordable Care Act (PPACA) to regulate new Accountable Care Organizations (ACOs).  According to CMS, ACOs are groups of health care providers that “work together to treat an individual patient across care settings, including doctor’s offices, […]

NYS Department of Health Announces Plan to Add Community First Choice Option to State Medicaid Plan

On March 18, 2011, Commissioner of Health, Nirav R. Shah, M.D., M.P.H., announced that the Health Department would begin the process of amending the State Medicaid Plan to add a new federal model for community based long term care.  The new program, called the Community First Choice Option, will be targeted at providing long term […]