In an effort to gain market access for new drugs and to shift the conversation from one of “volume” to one of “value,” pharmaceutical manufacturers are increasingly offering and agreeing to alternative payment models that set the price of a... Read More
On January 30, 2023, the Biden Administration announced that the COVID-19 Public Health Emergency (“PHE”), which has been in effect since January 2020, is set to expire on May 11, 2023. Considering the impending end to the PHE, healthcare... Read More
The National Cancer Institute (NCI), a part of the National Institutes of Health (NIH), selected four academic institutions to award $23 million to establish centers of excellence to research delivery of cancer-related care through telehealth. The... Read More
The U.S. Attorney’s Office for the Eastern District of Pennsylvania recently announced several False Claims Act settlements and a new complaint against a Kansas chiropractor concerning allegations of improper billing for the use of certain P-Stim... Read More
The pandemic exposed, among other things, some of the shortcomings facing long-term care facilities. Being well-aware of the persistent issues long-term care facilities have with resources, the federal government nevertheless pushed for... Read More
Senior Counsel Theresa DiGuglielmo, Esq., whose regulatory healthcare practice includes work with Behavioral Health providers, recently interviewed James M. Tudor, CPC, PCA, Director of Billing Compliance for HealthCare Compliance Network... Read More
As the nation reels from the heartbreaking COVID-19 pandemic, scrutiny of Skilled Nursing Facilities and Long-Term Care facilities is all but certain to continue. Industry leaders and recent data suggests providers anticipate enhanced oversight from... Read More
On April 26, 2021 the Office of Inspector General (“OIG”) in the U.S. Department of Health and Human Services (“HHS”) issued a new Advisory Opinion Letter providing its analysis as to whether a “Proposed Arrangement” involving an... Read More
Physician groups contracting with government-regulated health plans such as Medicare-Advantage Organizations, Medicaid Managed Care Organizations, or ACA Marketplace Individual/Small Group Issuers often enter into capitated payment models with... Read More
Following the release of an April 16, 2021 HHS Office of Inspector General (“OIG”) report entitled “Medicare Advantage Compliance Audit of Diagnosis Codes that Humana, Inc. (Contract H1036) Submitted to CMS” (the “OIG Report”), headlines... Read More
