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New Medicare Shared Savings Program Proposed Rule for Accountable Care Organizations

The Centers for Medicare & Medicaid Services (CMS) recently issued a proposed rule, which would institute a number of major changes to the Medicare Shared Savings Program (MSSP) for Accountable Care Organizations (ACOs). The proposed rule, which creates a redesigned program titled "Pathways to Success," changes the overall structure of the MSSP, and requires ACOs to assume more risk than they are required to under the current MSSP. Under the...

OIG Says Most Healthcare Providers are Not Appealing Medicare Advantage Claim Denials that are Likely to Be Overturned

During the last week of September 2018, the Office of the Inspector General (OIG) issued their findings on their review of the appeals process for Medicare Advantage (MA) plans. The report found that a significant number of Medicare Advantage Organizations (MAOs) overturned their own claim denials in 75% of filed appeals. The OIG report also found that only 1% of claims denials were appealed. This meant that in many circumstances...

Opioid Prescribing – Addressing Patients’ Needs While Avoiding Pitfalls

https://www.youtube.com/embed/IytgD0VHPUk In this recorded webinar, John E. Morrone, Esq., addresses opioid prescribing and avoiding pitfalls, including: • HHS’s 5-Point Strategy to Combat the Opioid Crisis • CDC Guidelines • State law limitation on prescribing • DEA enforcement and compliance • Compliance planning to avoid regulatory scrutiny • Naloxone prescribing and patient education This webinar will help prescribers: • Gain greater understanding of most up-to-date regulatory measures and enforcement actions •...

How Healthcare Providers’ Businesses Can Recover from the Impact of a Hurricane

Hurricanes, like the recent Hurricane Florence that hit North Carolina and South Carolina, can cause massive economic harm and property damage to physician practices, hospitals, pharmacies, and healthcare providers of all kinds. Business loss may include loss of patients, inventory, files, equipment, and the inability to continue operating the business. Other potential losses include the loss of payor contracts, adverse impact on wholesaler and distributor arrangements, licensing issues and prescription...

The California Insurance Commissioner’s Suit Against AbbVie Highlights Lurking Risks Under State Insurance Fraud Prevention Acts

Earlier this week, the California Insurance Commissioner filed a wide-ranging lawsuit against AbbVie, alleging classic illegal kickbacks to physicians as well as an intricate network of "nurse ambassadors" designed to improperly boost prescriptions for Humira, and seeking over $1.2 billion in damages.  Apart from representing a growing scrutiny on pharmaceutical manufacturers and other ancillary providers supplying nursing services allegedly in an effort to supplant the role of the prescribing physician,...