Searching Content by Ken Yood from Sheppard Mullin Richter & Hampton ordered by Published Date Descending.
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Cross-Plan Offsetting In The Balance: UnitedHealth Group, Inc. Petitions The Supreme Court To Allow Cross-Plan Offsetting; Response To Be Filed On Or Before July 31, 2019
In its decision, the Court concluded that UnitedHealth Group, Inc. ("United") was not authorized to engage in "cross-plan offsetting." What is cross-plan offsetting? It is a "self-help"
United States
16 Jul 2019
CMS Proposes Changes To Medicare Wage Index That Would Increase Reimbursement Rates To Rural Hospitals At The Expense Of Urban Hospital
On May 3, 2019, the Centers for Medicare & Medicaid Services ("CMS") published a comprehensive proposed rule to revise the Medicare payment structure for inpatient prospective payment systems hospitals.
United States
8 Jul 2019
Recent Activity In Medicare Audit Programs: CMS Announces Increase In Audit Contractor Oversight
The Centers for Medicare and Medicaid Services ("CMS") healthcare audit programs have been the subject of regular complaints and calls-for-action by the Medicare/Medicaid provider community for many years.
United States
12 Jun 2019
Years In The Making: The Health Resources & Services Administration Launches A Website To Increase Pricing Transparency In The 340B Program
If you overheard Medicaid providers breathe audible sighs of relief on April Fool's Day, it may be because on April 1, 2019
United States
10 May 2019
FDA Issues Warning Letter To Lab Marketing Three Laboratory-Developed Tests
In an April 4, 2019 Press Release, the U.S. Food and Drug Administration (FDA) announced its issuance of a Warning Letter to Inova Genomics Laboratory (Inova) in Virginia for marketing genetic
United States
6 May 2019
Cybersecurity, Inside Jobs, Outside Jobs, And HIPAA
According to a February 12, 2019 Press Release from Protenus, a developer of analytics for patient privacy monitoring and compliance,
United States
27 Mar 2019
HHS Proposes Rule To Eliminate Safe Harbor For PBM Drug Rebates
On February 6, 2019, the Office of the Inspector General of the U.S. Department of Health and Human Services (the "OIG") published in the Federal Register...
United States
18 Feb 2019
California AG Aims To Block County's Purchase Of Two San Jose-Area Hospitals
On January 9, 2019, California Attorney General Xavier Becerra filed a motion with the U.S. Bankruptcy Court for the Central District of California – Los Angeles Division (the "Court") ...
United States
24 Jan 2019
"Pathways to Success" Update: CMS Issues Final Rule On Changes To The ACO Program
As discussed in our August 16, 2018 blog post, CMS Proposes Massive Changes to ACO Program – Pushing Providers to Accept Downside Risk, on August 9, 2018
United States
11 Jan 2019
What Say You, New York? Now That Federal Antitrust Regulators Have Approved CVS's Proposed Acquisition Of Aetna, Attention Turns To New York State
During a public hearing in New York City on Thursday, October 18, 2018, New York State regulators, including Superintendent Maria Vullo of the New York State DFS, threatened to block CVS Health's $69 billion merger...
United States
26 Oct 2018
Congress Passes "SUPPORT For Patients And Communities Act" — A Rare Example Of Bi-Partisanship
In a September 14, 2018 Proclamation, President Donald Trump announced that the week of September 16 through September 22, 2018 would be Prescription Opioid and Heroin Epidemic Awareness Week ("Awareness Week").
United States
16 Oct 2018
The Merit-Based Incentive Payment System's Targeted Review Deadline Is Upon Us: Physicians, Groups, And Other Clinicians Have Until October 15, 2018 To Identify And Report Errors In The Calculation Of Their 2017 MIPS Final Scores
The Centers for Medicare & Medicaid Services (CMS) recently announced that it has several "prevailing concerns" regarding the accuracy of the 2017 Merit-Based Incentive Payment System
United States
9 Oct 2018
No Longer In Suspense: CMS Issues Final Rule Announcing That Risk Adjustment Program Transfers For 2017 Will Be Distributed In September
In a Final Rule posted by CMS last Tuesday, July 24, 2018, CMS announced that $10.4 billion in "risk adjustment transfers" for benefit year 2017 would be distributed to eligible exchange-participating insurers...
United States
6 Aug 2018
340B Drug Pricing Program Litigation Update: American Hospital Association, Et Al. v. Azar
On July 17, 2018, the Court of Appeals for the D.C. Circuit upheld the D.C. District Court's decision to dismiss the lawsuit led by the American Hospital Association
United States
24 Jul 2018
Humana, TPG Capital, And Welsh, Carson, Anderson & Stowe Create The Country's Largest Hospice Provider, "Kindred At Home"
As announced by the Consortium, Kindred Healthcare will be operated as a separate specialty hospital company owned jointly by TPG and Welsh.
United States
18 Jul 2018
The VA MISSION Act: Enhancing Healthcare For Veterans
On Wednesday, June 6, 2018, President Trump signed into law the "John S. McCain III, Daniel K. Akaka, and Samuel R. Johnson VA Maintaining Internal Systems and Strengthening Integrated Networks Act"...
United States
13 Jun 2018
The Shape Of Healthcare: Blockbuster Mergers, Retail Healthcare, And Marcus Welby, M.D
It has been widely reported that healthcare mergers and acquisitions are off to a strong start this year after ending a record-breaking year in 2017.
United States
31 May 2018
Direct Primary Care Legislation Continues Its Roll Across The Country: Florida Governor Rick Scott Signs Florida House Bill 37, Direct Primary Care Agreements
DPC is a style of clinical practice in which a healthcare provider offers primary care services to patients who pay a monthly membership fee for the provision of primary care services at no additional charge...
United States
5 Apr 2018
340B Drug Pricing Program Litigation Update
n November of last year, we wrote about a preliminary injunction being sought by hospital advocacy groups attempting to stop implementation of the Trump administration's cuts ...
United States
8 Jan 2018
CVS Health To Acquire Aetna
On December 3, 2017, CVS Health, a giant in the retail pharmacy industry, announced plans to acquire Aetna. Aetna is one of the largest medical insurers in the nation ...
United States
7 Dec 2017
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