Health Care Law Blog
On August 5, 2014, the Michigan Supreme Court (the "Court") declined to reconsider its decision to reject two class actions and a qui tam action against CVS Caremark Corporation, Rite Aid of Michigan, Inc., and several other pharmacies. The lawsuits were based on allegations that the companies had overcharged Medicaid for generic prescription drugs.
The underlying case was argued before the Court on January 16, 2014, and the Court ruled against the plaintiffs on June 11, 2014. The plaintiffs argued that the pharmacies violated Michigan Public Health Code, MCL 333.17755(2), which requires a pharmacist to “pass on the savings in cost” when dispensing a generic drug instead of a brand name drug.
The Centers for Medicare & Medicaid Services ("CMS") recently
announced proposed changes to the Medicare home health prospective payment
system (“PPS”) for the 2015 calendar year. CMS is proposing to tighten eligibility
requirements for home health services
and set a minimum requirement on Home Health Agencies ("HHAs") to
prove their effectiveness, as well as revise how much CMS will pay for certain
services. These proposed changes are expected to reduce Medicare payments to
HHAs by $58 million next year alone, a reduction of .30 percent.
To qualify for the Medicare home health benefit, a beneficiary must be under the care of a physician, have a need for skilled nursing care, physical therapy, speech-language pathology, or continued need for occupational therapy. Further, the beneficiary must be homebound and receive home health services from a Medicare approved agency.
The proposed changes include the following:
The Office of the Inspector General for the United States Department of Health and Human Services (the “OIG”) recently issued a Special Fraud Alert regarding laboratory payments to referring physicians (the “Alert”). The Alert relates to two types of compensation arrangements - Specimen Processing Arrangements and Registry Arrangements - between clinical laboratories and physicians who order clinical laboratory tests that the OIG believes present a substantial risk of fraud and abuse under the federal anti-kickback statute.
The United States Court of Appeals for the Sixth Circuit has
upheld Michigan’s tax on paid health care claims in an opinion published on
August 4. The decision has very significant implications for the State of
Michigan, which uses the revenues to partially fund the Medicaid program, and
for employers, group health plans, and third-party administrators, which are
subject to the tax.
