Supreme Court hears arguments on the constitutional challenge to the Patient Protection and Affordable Care Act *

USA - April 12 2012
From March 26 to 28, the U.S. Supreme Court heard oral arguments on the 26-state challenge to the Patient Protection and Affordable Care Act (PPACA or Act).

Co-authors: Robert M. Wolin, Larry J. Obhof, Jr., Christopher J. Swift.

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Medicaid audits: OIG report finds system flawed *

USA - March 29 2012
The HHS Office of Inspector General (OIG) recently released a report which found that problems with Review Medicaid Integrity Contractors' (Review MICs) data analyses led to poorly identified audit targets.

Co-authors: Ameena Ashfaq.

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Health plan flexes its muscle: providers face out-of-network challenges *

USA - March 1 2012
In a recent lawsuit filed in Harris County, Texas, Aetna Health Insurance, Inc., took on the issue of out-of-network discounts provided by physicians and other facilities to the patient financial obligation (copayment and deductible requirements), as well as the tie between the out-of-network discount to ownership interests held by physicians in the out-of-network facility.

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Payment under the ACO final regulations: it's all in the math! *

USA - December 8 2011
Since the promulgation of the final Medicare Shared Savings regulations governing the creation and payment of ACOs on October 20, 2011 (Final Rule), CMS has held several training sessions and discussions and accepted its first letters of intent on December 1, 2011.

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A sign of the times: the CMS bundled payments for care improvement initiative *

USA - September 1 2011
The Bundled Payments for Care Improvement Initiative (Bundled Payment Initiative) was launched by the Center for Medicare & Medicaid Innovation (CMMI) on August 23 as a separate and new initiative from one that may otherwise be undertaken pursuant to Section 3023 of the Patient Protection and Affordable Care Act (PPACA) -- The National Pilot Program on Payment Bundling.

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