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CMS Seeks to Lower Costs and Increase Competition with Step Therapy for Medicare Part B Drugs
  • Mintz Levin Cohn Ferris Glovsky and Popeo PC
  • USA
  • August 15 2018

As a continuation of the recent drug pricing developments tied the Trump Administration’s American Patients First Blueprint, beginning January 1, 2019

CMS Liberalizes Medicare Advantage and Part D Marketing Rules
  • Manatt Phelps & Phillips LLP
  • USA
  • July 31 2018

On July 20, the Centers for Medicare & Medicaid Services (CMS) issued the new “Medicare Communications and Marketing Guidelines” (MCMG), which governs

Recent Developments in Provider v. Payer Litigation -- Medicare Advantage Disputes
  • K&L Gates
  • USA
  • July 26 2018

In this episode, Gary Qualls discusses a recent development in payer litigation, regarding a provider’s recovery of Medicare Advantage payments

The Promise of All-Payer Claims Databases
  • Manatt Phelps & Phillips LLP
  • USA
  • July 19 2018

All-Payer Claims Databases (APCDs) are some of our nation’s most powerful healthcare data assets, yet information about what they are, the populations

CMS Considering New Medicare Advantage Payment Arrangement Incentive (MAQI) Demonstration
  • Reed Smith LLP
  • USA
  • July 5 2018

CMS is planning a new “Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) Demonstration” that would allow clinicians who participate

CMS Removes Compliance Training Requirements for Downstream Providers Under Medicare Advantage and Part D
  • Hall Render Killian Heath & Lyman PC
  • USA
  • July 5 2018

The Centers for Medicare & Medicaid Services (“CMS”) recently enacted a Final Rule removing certain compliance training requirements previously

Capitation Payments Aside, Transactions Between Government-Sponsored Managed Care Plans and Their Providers or Suppliers, Tainted by ‘Kickbacks,’ Are a Potential False Claims Act Violation, Says Court
  • Cadwalader Wickersham & Taft LLP
  • USA
  • June 29 2018

Earlier this month, the federal District Court for the Northern District of Illinois, in U.S. ex rel. Derrick v. Roche Diagnostics Corp., sustained a

Healthcare Finance: Court ruling gives Prime hospitals the right to sue Humana over Medicare Advantage contracts
  • Buchalter
  • USA
  • June 25 2018

In what an attorney for the health system has called a precedent-setting victory for in-network Medicare Advantage providers, a federal court has

CMS Issues Letter Prohibiting Pharmacy ‘Gag Clauses’ for Part D Plan Sponsors in First Step to Lower Drug Prices
  • Arent Fox LLP
  • USA
  • May 22 2018

On May 17, 2018, CMS issued a strongly-worded letter to Part D plan sponsors stating that pharmacy “gag clauses” are unacceptable. “Gag clauses”

ML Strategies Health Care Preview - Week of May 21st
  • Mintz Levin Cohn Ferris Glovsky and Popeo PC
  • USA
  • May 21 2018

This week, various health care programs in need of reauthorization will be reviewed by the relevant House and Senate Committees. The Senate will be