Rachel Landauer

Subscribe to Rachel Landauer's Posts
Contact:Read more about Rachel Landauer

A recent Senate Finance Committee hearing investigated the effects of physician-owned distributorships (“PODs”) on costs of care and patient safety, suggesting that the momentum for greater oversight of such business arrangements continues to build.[1]
Continue Reading Federal Spotlight Continues to Shine on Physician-Owned Distributorships

Messaging applications are popular tools to facilitate communication and workflow in healthcare settings—increasingly so as smart phones, tablets and other mobile mediums continue to penetrate the market. Organizations relying on or acquiescing in the use of informal messaging platforms, however, should be aware of the risk for data breaches and other HIPAA liability.
Continue Reading Communications Compliance: Are Messaging Applications Leaving Your Organization Vulnerable to HIPAA Liability?

Medicare Part D’s Medication Therapy Management (MTM) program intends to optimize clinical benefits and avoid drug-related problems among eligible beneficiaries. MTM services—involving pharmaceutical and clinical interventions—are offered at no cost to beneficiaries who meet criteria related to annual Part D drug costs, the prevalence of chronic diseases and number of prescription drugs.[1]
Continue Reading The Next Rx: New Medicare Part D Initiative Advances Role of Medication Management in Reform

Recently, the D.C. Circuit Court of Appeals ruled in Home Care Association of America, et al. v. Weil, that the Department of Labor’s (“DOL”) regulations about the inapplicability of certain statutory exemptions for third-party employers of home care workers are enforceable and that the federal minimum wage and overtime rules will apply to these types of home care workers. As a result, unless the Rule’s application is stopped or otherwise delayed, those acting in the home care industry need to be aware of changes soon to take effect, and employers in particular must be ready to meet their new obligations, as of October 15, 2015.
Continue Reading Home Care Associations Seek Stay by SCOTUS of New Wage-and-Hour Rules, As the Effective Date of DOL Wage-and-Hour Regulations Quickly Approaches

The “Two-Midnight” rule is a Centers for Medicare and Medicaid Services (“CMS”) billing policy which bases the appropriateness of payments for inpatient services under Medicare Part A versus Part B on provider expectations regarding length of stay.  It has been a source of controversy since its inception in 2013.  In addition to receiving an extended enforcement delay through September 30, 2015, the rule has been debated in Congress on multiple occasions including a House Ways and Means Committee Health Subcommittee hearing on hospital issues in May 2014 and a Senate Special Committee on Aging Hearing in July 2014. Last week CMS responded via a proposed rule that seeks to improve the applicability of the policy and simultaneously demonstrates that the agency continues to stand behind it.[1]
Continue Reading CMS Proposes to Modify—but Continues to Stand Behind—its “Two-Midnight” Rule

One of the most highly anticipated decisions of the term—at least among the Sheppard Mullin Healthcare team—was issued today by the Supreme Court: King v. Burwell.[1]   Six of the justices, including Chief Justice Roberts, voted to uphold the Administration’s interpretation of the law, leaving the availability of tax credits to people insured on the federal exchange and the current status quo in place.
Continue Reading The Supreme Court Upholds The Availability Of Subsidies On The Federal Exchange—Where Do We Go From Here?

The Massachusetts Attorney General and others are currently advocating for legislation that would accord greater legal weight to the findings of an independent state agency, the Health Policy Commission, on the effects of proposed mergers and acquisitions.[1]  Currently, a “Cost and Market Impact Review” report is referred to the Attorney General’s Office if the Health Policy Commission determines that a transaction will likely result in a provider gaining a dominant market share, higher prices for services and increased medical spending. Under the legislation, such a report would be prima facie evidence that a transaction violates the Massachusetts Consumer Protection Act and could be used in an action brought by the Attorney General to block the transaction pending the outcome of litigation.
Continue Reading State Oversight of Anticompetitive Activity in Healthcare: Is a New Wave Ahead?

On March 31, 2015, the U.S. Supreme Court issued its decision in Armstrong v. Exceptional Child Center, Inc., holding that Medicaid providers cannot sue to enforce reimbursement standards set forth in federal Medicaid law.[1]
Continue Reading The Supreme Court Holds That Medicaid Providers Cannot Sue To Enforce Federal Reimbursement Rate Standards

CMS recently released results of Medicare’s value-based payment modifier for 2015.[1]  This is the first year in which physicians are subject to adjustments under the payment system and, in this first phase of implementation, only affects practices with 100 or more eligible professionals.  
Continue Reading Time is Running Out to Avoid the Negative Effects of 2016 Value-Based Physician Payment Modifiers: CMS Releases Results of Medicare’s Value-Based Payment Modifier for 2015 as Final PQRS Participation Deadlines for 2016 Adjustments Approach

Cancer care is notoriously complex, intensive and costly. With more than 1.6 million people diagnosed with cancer each year, there is a strong impetus towards reforming service delivery. Accordingly, the U.S. Department of Health and Human Services is launching a new payment and care delivery model for Medicare beneficiaries undergoing chemotherapy treatment.[1]
Continue Reading HHS Launches New Payment and Delivery Model to Improve Oncology Care