Health Law Alert

We recently reported on the “Low Volume Appeals (LVA) Settlement” process initiated by the Centers for Medicare and Medicare (CMS) that was implemented during March and April 2018. (See February 2, 2018 Health Law Advisory.) Many, including the American Hospital Association (AHA), have asserted that the LVA process is insufficient […]

Secretary of Health and Human Services Alex Azar has put the health care industry on notice that he intends to seek what he terms a “value-based transformation” of the American health care system. The former pharmaceuticals executive wasted no time after his January 2018 confirmation in making price transparency one […]

In Gilmore v. Holland, decided in February 2018, the U.S. District Court for the Middle District of Pennsylvania held that the Emergency Medical Treatment and Labor Act (“EMTALA”) does not apply to a patient who has been admitted for an inpatient procedure who develops post-surgery complications. In his complaint, Mr. […]

The OIG recently issued an advisory opinion permitting an excluded individual to be employed to market medications to pharmacies that participate in Medicare and Medicaid. Advisory opinions are limited to the specific individuals and facts addressed, so the decision cannot be read as general policy. It does, however, mark a […]

CMS has long taken the position that payments to hospitals under the Medicaid Disproportionate-Share Hospital program (“DSH”) should be reduced to take into account any reimbursement from the Medicare program or third-party insurers for treatment of Medicaid beneficiaries. In February, the U.S. District Court for the Western District of Missouri […]