Health Care

Recent Posts

Williams Mullen: Health Care Providers Lacked Standing to Sue as ERISA Beneficiaries: Rojas v. Cigna Health and Life Insurance Company
Posted on 28 Jul 2015 by Williams Mullen

By Mark S. Thomas The U. S. Court of Appeals for the Second Circuit has affirmed a dismissal of claims by two physicians and their medical practice asserting standing under ERISA to enjoin an insurer from removing them from its coverage network. Rojas... Read More

Williams Mullen: OIG 2014 Work Plan Focuses On Compounded Pharmaceuticals Reimbursed By Medicare
Posted on 14 Feb 2014 by Williams Mullen

By Brian C. Vick The Office of Inspector General for the U.S. Department of Health and Human Services (“OIG”) included two items in its recently-released 2014 Work Plan indicating a new focus on the quality and safety of compounded pharmaceuticals... Read More

Williams Mullen: OIG 2014 Compendium Highlights Need For Improved Controls For Pharmacy Claims Submitted To Medicare Part D Plans For Payment
Posted on 30 May 2014 by Williams Mullen

By Brian C. Vick and C. Elizabeth Hall In its March 2014 Compendium of Priority Recommendations (the “Compendium”), the Office of the Inspector General of the United States Department of Health and Human Services (“OIG”) identified... Read More

Williams Mullen: CMS Proposes Rule That Would Expand Its Authority To Audit Medicare Advantage Plans
Posted on 30 May 2014 by Williams Mullen

By Brian C. Vick O n April 30, 2014, the Centers for Medicare and Medicaid Services (“CMS”) issued a proposed rule to update payment policies and rates for inpatient hospitals (the “Proposed Rule”) that includes a provision... Read More

Williams Mullen: Preparing for a Data Breach – What to Know about Breach Notification
Posted on 8 Apr 2015 by Williams Mullen

By Kelsey S. Farbotko Data breaches are at the forefront of the news, and many companies, including those dominant in the health care industry, have found themselves front and center in the headlines. Although recent news stories have focused their... Read More

Williams Mullen: OIG Scrutiny of Hospital Outpatient Evaluation/Management Claims Billed to Medicare
Posted on 11 Feb 2014 by Williams Mullen

By Marcus C. Hewitt H.H.S’s Office of Inspector General’s yearly work plan was issued on January 31, 2014, which included numerous new and ongoing reviews and activities by OIG for the coming year. Among the new projects, OIG will review... Read More

Williams Mullen Health Care Fraud and Abuse Alert: What CMS’s New Billing Requirement For ‘Incident To” Services Means For Medicare Providers
Posted on 3 Jan 2014 by Williams Mullen

By Brian C. Vick In the final Medicare Physician Fee Schedule for 2014 (“2014 PFS”), CMS implemented a new condition of payment for “incident to” services that has significant fraud and abuse implications for any Medicare provider... Read More

Williams Mullen: Affirming the Need to Fix the Medicare Appeals Backlog: The AFIRM Act of 2015
Posted on 29 Jul 2015 by Williams Mullen

By: Kelsey S. Farbotko If you are one of the many health care providers wanting to appeal a Medicare contractor’s reimbursement decision, you may need to be prepared for a long wait. Over the last few years, the backlog of appeals to the administrative... Read More