CMS Continues Mission on Integrity with Affiliations Final Rule

Last week, the owner and CEO of Video Doctor Network pled guilty to a $424 million Medicare kickback scheme. He admitted to receiving kickbacks and bribes from recruiters, pharmacies and brace suppliers in turn for arranging doctors to order medically unnecessary orthotic braces for Medicare beneficiaries. As reported by Healthcare Dive, this is one of the largest schemes to defraud Medicare ever investigated by the Federal Bureau of Investigation (FBI) and the Health and Human Services (HHS) Office of the Inspector General and prosecuted by the Department of Justice.

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HMA Conference Recap

The Health Management Associates (HMA) conference brought together hundreds of industry executives from health plans, governments and community-based organizations serving Medicaid, Medicare and vulnerable populations. Set in Chicago, Illinois, the conference shed a light on the challenges and opportunities for health care entities in the publicly sponsored health care arena.

In case you were not able to attend, here is a recap of the key topics discussed:

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CBO Report: A New Framework on Single-Payer Health Care

Earlier this month, the Congressional Budget Office (CBO) released a report outlining options and technicalities lawmakers need to consider to establish a single-payer health care system in the United States. Although a lot to assess, the “single-payer” term generally refers to a system in which health care is paid for by a single public authority, as stated by Kaiser Health News (KHN). While once a pipe dream, this topic is officially mainstream and cultivating questions quickly.  

Here’s what you need to know: 

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Texas leads multi-state Affordable Care Act lawsuit

In February 2018, the attorney general of Texas, joined by attorneys general and governors from nineteen other Republican states, filed a lawsuit asking a Texas judge to invalidate the entire ACA.  

Their theory is that during a Supreme Court argument held in 2012, Congress lacked constitutional authority to enact the ACA’s individual responsibility requirement as a mandate, but upheld it as a tax. In 2017, Congress zeroed out the tax, thus, plaintiffs argue, the individual responsibility requirement now lacks any constitutional basis and is void. But, the argument continues, the individual responsibility requirement is key to all the rest of the ACA, so the entire ACA must be invalidated. In April, the plaintiff states (joined by two individual plaintiffs) asked the court to block the enforcement of the ACA and all associated regulations through a preliminary injunction. 

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