From its inception the 340B program has been the subject of disputes between drug manufacturers and their safety-net hospital customers. On August 12 HHS proposed an administrative process for resolving those disputes. Established in 1992, the 340B program requires manufacturers to enter into pharmaceutical …
Shocking News: Congressional Debate on Obamacare Gets Partisan
March 17, 2016 Leave a Comment
In one of the more unexpected developments in recent Congressional history, a House Ways & Means Committee vote relating to the Affordable Care Act (ACA) turned partisan. Astonishingly, all the Republicans voted one way; all the Democrats voted the other way. The partisan split was all the more unexpected …
Finally, A Final Rule on ACA’s 60-Day Repayment Rule
February 12, 2016 Leave a Comment
On February 11, 2016, CMS released the much anticipated final rule on the so-called “60-day rule.” The long road to the final rule began when the Affordable Care Act (ACA) established the 60-day deadline for returning Medicare and Medicaid overpayments. The clock started running from the time an overpayment …
Two More Hospitals Qualify for Exception to Exception to Grandfather Exception to Elimination of Whole Hospital Exception to Stark Law Prohibition
September 17, 2015 Leave a Comment
The Stark Law generally prohibits physicians from referring Medicare and Medicaid patients to facilities in which they have an ownership interest. There used to be a “whole hospital exception” excluding entire hospitals (as contrasted to departments or parts of hospitals) from the prohibition. The …
Whistleblower Filed Too Early & Too Late for Share of $322M SCAN Scam Recovery
September 2, 2015 1 Comment
In a miracle of bad timing, Jim Swoben managed to lose out on a share of the $322 million recovery against SCAN health Plan by being both too early and too late in filing his qui tam action. During his days as a data encounter manager at SCAN, Jim suspected the company had been double-billing Medicare and …
HHS POISED FOR ROUND TWO OF ORPHAN DRUG FIGHT
June 16, 2014 Leave a Comment
HHS isn’t ready to throw in the towel in the fight over expansion of the 340B program under the Affordable Care Act (ACA). On Thursday HHS said in a court filing that it will appeal last month’s federal court ruling that struck down a regulation issued by the Health Resources & Services …