The Centers for Medicare and Medicaid Services (CMS) refused to count days of care for the plaintiff hospitals' Pennsylvania GA patients on the stated basis that those patients are not "eligible" to receive benefits under the federal Medicaid program.
In a class action lawsuit, the U.S. Court of Appeals for the 7th Circuit recently affirmed a lower court decision granting a preliminary injunction that prevented the state of Indiana from enforcing a $1,000 annual cap on Medicaid coverage for medically necessary dental services.
In a heavily anticipated landmark ruling, the Supreme Court has upheld the constitutionality of the so-called "individual mandate" of the Affordable Care Act – i.e., the requirement that those not insured privately, through their employer or through a governmental program, must either purchase minimum essential health insurance coverage or pay a "penalty" for failing to do so.
On February 16, 2012, the Centers for Medicare & Medicaid Services (CMS) issued a widely anticipated proposed rule (the proposed rule) implementing the statutory requirement of Section 6402(a) of the Affordable Care Act (the ACA) that providers and suppliers report and return overpayments from Medicare and Medicaid.
The Patient Protection and Affordable Care Act (the "PPACA") of 2010 as amended by the Health Care and Education Reconciliation Act of 2010 (the "Reconciliation Act") (collectively referred to as "the Health Care Reform Act") includes a number of new reporting requirements designed to enhance the transparency of certain segments of the health care industry including manufacturers of drugs, medical devices, biologicals and medical supplies.
Our Health Law Alert of April 26, 2010 summarized recent amendments to the Anti-Kickback Statute ("AKS") concerning "reverse" federal false claims act ("FCA") and the implications of the requirement of Section 6402 of the Patient Protection and Affordable Care Act of 2010, Pub. L. No. 111-148 (the "PPACA") to report and refund "overpayments" by Medicare and Medicaid within sixty (60) days of "identification."
Highmark, Inc. has filed a lawsuit in the Commonwealth Court of Pennsylvania challenging the legality of an ongoing Pennsylvania Insurance Department investigation involving potential anticompetitive conduct and/or unfair trade practices by Pennsylvania’s Blue Cross and Blue Shield companies.