Category Archives: Industry Topics

11th Circuit: Difference in Opinion Not Enough for FCA Liability

By | October 14, 2019

The 11th Circuit’s long-awaited AseraCare opinion requires more than mere disagreement regarding clinical judgment to prove falsity under the False Claims Act. The 11th Circuit rejected the government’s theory of falsity in its long-running False Claims Act (FCA) case against long-term care provider AseraCare Inc. The 11th Circuit affirmed the lower court’s ruling that mere clinical disagreement was… Read More »

The OIG Urges CMS to Implement Solutions to Reduce Fraud in Medicare Part C and Part D

By | August 7, 2019

Recently, the Department of Health and Human Services (“HHS”) Office of Inspector General (“OIG”) issued its 2019 “Solutions to Reduce Fraud, Waste, and Abuse in HHS Programs: Top Unimplemented Recommendations.”  The OIG releases a version of this report each year outlining its top 25 unimplemented recommendations to reduce fraud, waste, and abuse (“FWA”) among HHS programs.  This blog post… Read More »

Call for Speakers!

By | May 10, 2019

Have you heard? The HFMA MA-RI Revenue Cycle Committee is seeking speaker and presentation proposals for its 2020 Annual Revenue Cycle Conference (RCC) to be held on January 16th and 17th at the Gillette Stadium Clubhouse, Foxboro, MA. Share your expertise, raise your professional profile, and help advance the state of the art and best practices relating to… Read More »

Emerging Medicaid ACOs: A State Experiment, One Year In

By | March 20, 2019

We hope you can join us on March 28th for the Health Care Delivery Transformation Committee’s first annual meeting, “Transformation or Disruption: Changing the Focus and Pace of Change in Healthcare Delivery.”  In the post below, Katherine Record discusses the transformative change in the MassHealth Program, one of the many topics to be covered at the meeting.  Last year,… Read More »

Are you curious about Value-based Care?

By | March 17, 2019

If you are interested in learning more about Value Based Care (VBC), join HFMA at the upcoming Health Care Delivery Transformation conferenceon March 28th. Joshua Mast, Senior Regulatory Strategist at Cerner will provide an introduction and foundation to this topic. He will be demystifying the alphabet soup of VBC, at a high level.  Joshua joined Cerner in September… Read More »

Transformation or Disruption? Registration is Open for Our Newest Conference

By | February 13, 2019

We are excited to announce that registration is now open for “Transformation or Disruption: Changing the Focus and Pace of Change in Healthcare Delivery.”  This conference is brought to you by our newly merged Healthcare Delivery Transformation Committee (formerly the EPM/PPM and Managed Care Committees).  The conference will take place on March 28, 2019 at the Four Points by… Read More »

Drug Pricing and Payment Policy: Key 2018 Developments and Potential 2019 Changes and Challenges

Following a number of drug pricing reforms implemented or proposed in 2018, 2019 likely will bring more action from HHS and Congress to reduce drug prices. Key Points: In 2018, the Administration implemented and proposed several policy changes to reduce drug prices or spending, and Congress passed new legislation prohibiting health plans from preventing pharmacies from informing plan… Read More »