Legal Solutions  Blog

The battle over the Affordable Care Act (ACA) has divided the country. Whether it is the individual mandate or the expansion of Medicaid, the issues focus on insurance.  Individuals do not want to be forced to purchase insurance and nearly half of the states do not want to expand their Medicaid coverage. However, without insurance, healthcare [...]

For over 14 years, the Office of Inspector General (OIG) has been encouraging Medicare and Medicaid providers to adopt voluntary compliance programs.   Since 1998, the OIG has issued compliance guidance to 11 healthcare sectors, including: Nursing Facilities ; Hospitals; Hospices; Durable Medical Equipment, Prosthetics, Orthotics, and Supply ( DMEPOS) businesses; Third-Party Medical Billers ; and Home Healthcare . However, under the Patient Accountability and Affordable Care Act [...]

The Departments of Health and Human Services, Labor, and the Treasury recently released the final rule implementing the Affordable Care Act’s requirement that non-exempt group health plans and health insurance issuers cover preventative services for women, including all FDA “approved contraceptive methods, sterilization procedures and patient education and counseling for all women with reproductive capacity.” This coverage begins [...]

Although those calling for the repeal of the Affordable Care Act (ACA) argue that it is a  job-killing, business crushing burden, there is one industry segment that has definitely profited under the ACA – health insurers . In fact, while lamenting the medical-loss ratio and rate increase review provisions of the ACA, health insurers have reported some of their highest profits of [...]

Americans now use  70 percent of the world’s legal supply of narcotics.  As a result, the number of deaths from narcotic overdoses has tripled in the last decade. Now, drug companies are developing pain pills that have 10 times the amount of the highly addictive painkiller hydrocodone as the current painkillers such as Vicodin. Although this might be good [...]

CMS has finally issued its proposed rule to require manufacturers of drugs, devices, biologicals, or medical supplies covered by Medicare, Medicaid, or CHIP to report payments or transfers of $10 or more made to physicians or teaching hospitals. Introduced in 2009 as the Physician Payment Sunshine Act , the requirements ultimately became Section 6002 of the Affordable Care Act (ACA). Section [...]

Last week, Pfizer lost the patent protection on its popular and profitable cholesterol-lowering drug Lipitor.  Patent protection for drugs lasts 20 years .  Typically, drugs that lose their patent protection also lose 80 percent of their sales.  No doubt part of the reason why Pfizer raised the price on Lipitor by 11.4 percent in 2010 . Lipitor had global sales of more [...]

In my last post, I discussed a few of the changes federal and state governments have made in their ongoing efforts to reduce Medicaid fraud.  However, there are also significant changes you should be aware of in the way the federal government is identifying and preventing healthcare fraud. In July, the Centers for Medicare & Medicaid Services [...]

In my last post, I discussed a few of the changes federal and state governments have made in their ongoing efforts to reduce Medicaid fraud.  However, there are also significant changes you should be aware of in the way the federal government is identifying and preventing healthcare fraud. In July, the Centers for Medicare & Medicaid Services [...]

If you haven’t been paying attention to recent reports on Medicaid fraud enforcement, now is the time to start. In 2010, Medicaid Fraud Recovery Units (MCFUs) recovered more than $1.8 billion.  And, although criminal convictions and plea agreements frequently make the news, the vast majority of this money – more than $1.6 billion – was recovered [...]

In mid-October, Wal-Mart Stores Inc., the largest U.S. retailer and the nation’s largest private employer, announced it will no longer offer health insurance to new part-time employees who work fewer than 24 hours a week.  The changes impact the 1.4 million U.S. employees in Walmart and Sam’s Club stores.  Including employees and their family members, Walmart now [...]

In the latest decision on the healthcare reform bill, the D.C. Court of Appeals upheld the Patient Protection and Affordable Care Act (PPACA).   In  Seven-Sky v. Holder , plaintiffs challenged the ” minimum essential coverage provision ,” commonly referred to as the individual mandate.  The provision requires individuals to purchase and maintain “minimum essential coverage” beginning in January 2014. [...]