The United States Supreme Court granted certiorari on January 10, 2014, in Pom Wonderful LLC v. The Coca-Cola Company. The Court must now decide whether the Food, Drug, and Cosmetic Act (“FDCA”) bars Lanham Act claims for deceptive naming
January 2014
Federal court holds against hospitals in Medicare outlier payments litigation
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On January 6, the US District Court for the District of Columbia granted summary judgment to the Department of Health and Human Services (“HHS”), upholding the agency’s method of calculating Medicare outpatient payments for hospitals. District Hospital Partners, L.P., d/b/a …
MedPAC recommends to Congress aligning Medicare payment rates between hospital outpatient payments and physician office payments for certain services
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On January 16 and 17, the Medicare Payment Advisory Commission (“MedPAC” or “Commission”) held its first public meeting of 2014. One topic the Commission debated was aligning Medicare hospital outpatient payments and physician office payments for certain services. Medicare payment…
OIG finds that MAC Local Coverage Determinations result in inconsistent Medicare coverage rules
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In Report OEI-01-11-00500 entitled “Local Coverage Determinations Create Inconsistency in Medicare Coverage” (January 2014), the Department of Health and Human Services’ Office of Inspector General (“OIG”) explained that it had reviewed Medicare Administrative Contractor (“MAC”) Local Coverage Determinations (“LCDs”). MACs…
US Department of Health & Human Services’ Office of Medicare Hearings and Appeals suspends assignment of new Medicare appeals to ALJs
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The US Department of Health & Human Services’ Office of Medicare Hearings and Appeals (“OMHA”) administers appeal hearings for the Medicare program.
There are five levels in the Medicare claims appeal process. OMHA’s Administrative Law Judges (“ALJs”) hold hearings and…
HHS announces modified policy on FOIA disclosure of Medicare payments made to individual physicians
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On January 17, the Department of Health and Human Services (“HHS”) published notice of a new policy regarding requests made under the Freedom of Information Act (“FOIA”) for information on amounts paid to individual physicians under the Medicare program. Under…
OIG report finds that MACs failed to meet 26 percent of reviewed quality-assurance standards
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Medicare Administrative Contractors (“MACs”) failed to meet 26 percent of quality-assurance standards reviewed by the Department of Health and Human Services Office of Inspector General (“OIG”), according to a new report. The OIG report found that MACs fell short on…
Congressional hearings indicate additional security flaws with healthcare website
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During a US House of Representatives Science Committee hearing last week, cybersecurity researchers described that the Affordable Care Act’s healthcare website, HealthCare.gov, is still susceptible to security issues, which could put patients’ sensitive health information at risk.
David Kennedy, president…
MedPAC considers significant changes to Medicare payments to acute care hospitals, long-term care hospitals, and physician groups for certain services
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The Medicare Payment Advisory Commission (“MedPAC”) during its December 12-13, 2013 meeting discussed potentially significant changes to certain Medicare payments to acute care hospitals, long-term care hospitals, and physician groups. One change would be to eliminate or reduce the payment…
New proposed rule would heighten fraud oversight for Medicare Part D
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The Centers for Medicare & Medicaid Services (“CMS”) published a proposed rule on January 7 that would revise the Medicare Advantage program (also known as Medicare Part C) and the prescription drug benefit program (Part D) regulations. The change would…