The Office for Civil Rights (OCR) at the U.S Department of Health and Human Services concluded an all-time record year in Health Insurance Portability and Accountability Act (HIPAA) enforcement activity. In 2018, OCR settled 10 cases and was granted summary judgment in a case before an Administrative Law Judge, together totaling $28.7 million from enforcement […]
Senators voice interest in Medicare Part D, Part B reforms
By Susannah Luthi | January 29, 2019 The Senate Finance Committee on Tuesday signaled interest in bolstering key points in the Trump administration’s drug-pricing blueprint, including potential structural reforms for Medicare Part B and Part D. Senators from both sides of the aisle waded into a proposal highly unpopular with physicians and hospitals, aimed at removing the incentive […]
HHS suggests transforming safe harbors for Part D drug rebates
By Robert King | January 31, 2019 HHS issued a long-awaited proposed rule on Thursday that excludes the rebates drugmakers pay to pharmacy benefit managers on Medicare Part D plans from protections from anti-kickback laws. The proposed rule also applies to safe harbor protections for Medicare managed-care organizations. The agency instead will propose new safe harbor […]
Nevada AG gets OK to hire law firm to sue opioid makers
By Colton Lochhead / Las Vegas Review-Journal January 30, 2019 – 7:32 pm CARSON CITY — The Nevada Attorney General’s office got the OK Wednesday to hire a law firm to sue opioid manufacturers. The Interim Finance Committee approved the request for the Attorney General’s office enter hire outside counsel on a contingency fee, meaning the […]
Part D plans would take on more financial risk under new CMMI model
By Susannah Luthi | January 18, 2019 The CMS Innovation Center on Friday announced a new model to try to shrink skyrocketing Medicare Part D drug spending, and expanded its so-called value-based insurance design model for Medicare Advantage plans across all 50 states. The strategy for Part D targets the high spend in the catastrophic phase […]
Supreme Court gears up to review Medicare DSH formula
By Susannah Luthi | January 14, 2019 The Supreme Court on Tuesday will hear arguments in an appeal over whether HHS can recalculate its Medicare disproportionate-share hospital payments without going through the full rulemaking process to get public input on the change. HHS petitioned the high court to take the case last spring, estimating that the government would have to pay […]
Tennessee physicians win $58 million judgment against Wellmont Health
By Harris Meyer | December 20, 2018 A physician independent practice association in Tennessee has won a $58 million class-action judgment against Wellmont Health System based on allegations that the system tried to undermine the IPA and signed payer contracts outside the physician network. Highlands Physicians, a 1,500-physician group based in Kingsport, Tenn., won the verdict Tuesday following a 13-day […]
Optum drops Nevada clinics from DaVita buyout amid antitrust scrutiny
By Jessie Bekker / Las Vegas Review-JournalDecember 20, 2018 – 6:20 pm UnitedHealth Group’s Optum is dropping plans to purchase the DaVita Medical Group physician clinics in Nevada after the Federal Trade Commission investigated the deal’s compliance with antitrust regulations. DaVita, in a U.S. Securities and Exchange Commission filing last week, indicated that while Optum will […]
A Holiday Wish for Our Clients
May the Spirit of the Season Bring You Peace, Health and Happiness with a Year Full of Abundance and Joy.
Colorado hospital failed to terminate former employee’s access to electronic protected health information
Pagosa Springs Medical Center (PSMC) has agreed to pay $111,400 to the Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services and to adopt a substantial corrective action plan to settle potential violations of the Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Rules. PSMC is a critical […]