Articles and Blogs

Beginning April 1, 2019, Medicare Part C and D plans, PACE organizations and 1876 cost contract plans (“Plans”) will be required to deny payment for services rendered or prescriptions ordered by any provider on the new Centers for Medicare & Medicaid Services (“CMS”) Preclusion List. The Preclusion List, which was first made available to... READ MORE

On January 29, 2019, the Department of Health and Human Services Office of Inspector General (“OIG”) published Advisory Opinion 19-02, which approved an arrangement allowing a pharmaceutical manufacturer to loan smartphones to financially needy patients in order to assist with medication adherence. OIG stated that it would not impose sanctions against the parties for... READ MORE

Recently, the Department of Health and Human Services Office of Inspector General (“OIG”) issued a favorable advisory opinion, Advisory Opinion 19-01, concerning a charitable pediatric clinic (the “Clinic”)’s arrangement under which the Clinic waives cost-sharing amounts for a small percentage of TRICARE and Medicare beneficiaries not covered by a state insurance program (the “Arrangement”). After... READ MORE

The U.S. Department of Justice and the Office of the Inspector General of the United States Department of Health and Human Services announced this month news of a Settlement Agreement and a Corporate Integrity Agreement (the “Agreements”) with Greenway Health, LLC (“Greenway”). The Agreements include a payment by Greenway of $57.25 million. Greenway customers... READ MORE

NATIONAL How to make healthcare more like Amazon? It comes down to data and payer-provider collaboration How hospitals will handle outpatient competition & disruption in 2019 White House reportedly reviewing final rule to reverse nursing home arbitration ban CMS Lifts Moratoria on Home Health After 5 Years Amazon’s PillPack secures more state licenses, could... READ MORE

S&P Global Ratings, Fitch Ratings and Moody’s Investors Service recently released their Nonprofit Healthcare 2019 Outlooks, which are largely consistent with 2018, despite changes in the health care industry over the past year. Fitch and Moody’s issued negative outlooks for the nonprofit health care sector, while S&P’s sector outlook was stable. Despite their differing... READ MORE

On January 31, 2019, the Department of Health and Human Services Office of Inspector General (“OIG”) issued a proposed rule that, if finalized, would eliminate Anti-Kickback Statute (“AKS”) safe harbor protection for prescription drug rebates paid by manufacturers to pharmacy benefit managers (“PBMs”), Medicare Part D plans and Medicaid managed care organizations (“Proposed Rule”).... READ MORE

NATIONAL Why hospitals’ future will involve keeping people from showing up GAO: Advantages of Voluntary and Mandatory Bundled Payments Study: Hospitals dramatically increase ad spend following data breaches Study finds freestanding EDs charge more than urgent care centers Stephen Klasko: Hospitals of the future won’t look the same Why some nonprofit hospitals are turning... READ MORE

The Oregon State Legislature is considering a bill that bases the determination of tax-exemption for hospital property on the relationship between hospital executives’ compensation and the amount of charity care provided by the hospital. While a number of other states have passed legislation that threatens a hospital’s property tax-exempt status where a hospital fails... READ MORE

NATIONAL GAO’s latest report on patient matching: It’s still not easy Fostering a culture of innovation: 5 CIOs share insights Research: Physician Burnout is a Public Health Crisis; Improving EHR Usability is Critical New drug shortages rose 27% in 2018 Telehealth and the law: What hospital executives should know about kickback and false claims... READ MORE