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 […]

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 […]

OMIG 2012-2013 Work Plan: A Brief Overview

“Fighting Fraud.  Improving Integrity and Quality.  Saving Taxpayer Dollars.” This phrase appears on each page of the newly released New York State Office of the Medicaid Inspector General (OMIG) State Fiscal Year 2012-2013 Work Plan. On the Executive Summary page, the OMIG’s stated mission is to “enhance the integrity of the New York State Medicaid […]

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 […]

Fourth Circuit Holds Virginia Lacks Standing to Challenge Individual Mandate

Today, in a unanimous decision authored by Judge Diana Gribbon Motz, the United States Court of Appeals for the Fourth Circuit ruled that the Commonwealth of Virginia has no standing to challenge the constitutionality of the individual mandate provision of the Patient Protection and Affordable Care Act (PPACA).  Unfortunately for those keeping a running tally, the […]

Providers and Insurers Look to Urgent Care Facilities to Lower Costs

The expected cuts to Medicare via the Patient Protection and Affordable Care Act (“PPACA”) have many health care providers and insurers assiduously reviewing various efficiency and spending measures.  The latest edition of the Albany Business Review  highlights one emerging trend in these efforts: steering individuals with minor ailments away from hospital emergency rooms and into “urgent […]