BCBS Reaches $2.8 Billion Settlement to Resolve Antitrust …
Dec 17, 2024 · Blue Cross Blue Shield (BCBS) – with 33 of its member companies – recently reached a proposed settlement, agreeing to pay $2.8 billion to settle allegations that BCBS plans violated antitrust laws by suppressing competition and underpaying providers for reimbursements from July 2008 to October 2024.This class action proposed settlement represents the largest antitrust payout to be awarded ...
CMS 2025 Physician Fee Schedule Includes 2.9 Percent Pay Cuts …
Dec 23, 2024 · The Centers for Medicare & Medicaid Services (CMS) has released the calendar year (CY) 2025 Revisions to Payment Policies under the Physician Fee Schedule (MPFS) and Other Revisions to Medicare Part B Final Rule, which includes proposals related to Medicare physician payments and the Quality Payment Program (QPP). Under the Final Rule, average payment rates under the PFS will be reduced by 2. ...
CVS Subsidiary Reaches $60 Million Settlement Over False Claims …
Nov 11, 2024 · Oak Street Health, a wholly-owned subsidiary of CVS Health since 2023, has agreed to pay $60 million to resolve allegations that it violated the False Claims Act (FCA) by paying kickbacks to third party insurance agents in exchange for their recruiting of seniors to Oak Street Health’s primary care clinics.. The United States alleged that prior to CVS’ ownership, in 2020, Oak Street Health ...
DOJ Resolves More than $1 Billion in False Claims Act Settlements …
Dec 18, 2024 · Gibson Dunn recently published a mid-year update on the False Claims Act (FCA) collections for the first half of the year, noting that “[t]he first half of 2024 is a reminder that [the flow of enforcement] can surge at any moment, bringing with it massive settlements.” The update notes that the Department of Justice (DOJ) continues to focus on cybersecurity and has reached False Claims Act ...
Navigating Change: SAMHSA’s New Federal Guidelines for Opioid …
Dec 6, 2024 · The Substance Abuse and Mental Health Services Administration (SAMHSA) has recently released a comprehensive updates to the Federal Guidelines for Opioid Treatment Programs (OTPs), reflecting the significant changes to the regulations published in February 2024. These new guidelines, which supersede those from 2015, offer detailed recommendations, guidance, and best practices for the ...
January 19, 2025 – Policy & Medicine
5 days ago · Welcome to this week’s edition of "This Week in Policy and Medicine, January 19, 2025," your trusted source for the latest…
Third Quarter False Claims Act Roundup – Policy & Medicine
Dec 31, 2024 · Oak Street Health marked another settlement, a $60 million settlement resolving allegations that the CVS subsidiary unlawfully compensated third-party insurance agents for making referrals or recommendations of their clients to Oak Street. The government specifically alleged that Oak Street paid insurance agents to contact seniors who were eligible for Medicare Advantage and market Oak Street ...
CMS Finalizes TEAM through IPPS Final Rule - Policy & Medicine
Nov 22, 2024 · On August 28, as part of its Fiscal Year 2025 Hospital Inpatient Prospective Payment System (IPPS) Final Rule, the Centers for Medicare & Medicaid Services (CMS) finalized the Transforming Episode Accountability Model (TEAM) – a mandatory, episode-based alternative payment model applicable to certain acute care hospitals paid under the IPPS. TEAM seeks to incentivize care coordination ...
What a Trump Presidency Could Mean for the Life Sciences Industry
Nov 8, 2024 · Trump’s priorities to fix the Affordable Care Act (ACA) mark a significant shift in the healthcare landscape. His return to office may bring renewed efforts to modify or repeal certain ACA provisions, including allowing states greater flexibilities in defining essential health benefits, limiting the individual and employer mandates, and reducing spending on Medicaid block grants.
January 2, 2025 – Policy & Medicine
Jan 2, 2025 · Legal, Regulatory, and Compliance Issues. The Centers for Medicare and Medicaid Services (CMS) found that Accountable Care Organizations (ACOs) and the Medicare Shared…