Insights

Washington – June 6, 2024: Crowell & Moring earned 78 rankings for 67 lawyers, as well as 41 national and statewide practice area rankings, in the Chambers USA 2024 guide. The rankings are driven by independent interviews of clients and lawyers at peer firms.

Washington, D.C. – June 22, 2022: Jed Wulfekotte joins Crowell & Moring’s Washington office as a partner in its Litigation and Health Care groups, where he will represent corporate clients as both plaintiffs and defendants in complex commercial litigation matters spanning a wide range of industries, most notably, health care, pharmaceuticals, life sciences, government contracts, and technology. He also will represent companies involved in False Claims Act investigations and qui tam litigation.    

On May 10, 2024, the Centers for Medicare & Medicaid Services (“CMS”) published a Final Rule that, for the first time, imposes national minimum nurse staffing requirements for nursing homes. Specifically, the standard adopted by CMS requires minimum staffing of 3.48 hours per resident day (“HPRD”), as discussed in more detail below. CMS estimates that the new requirements will cost facilities $43 billion over the next 10 years, which is more than the $40.6 billion cost that CMS estimated for Proposed Rule of 3.0 HPRD. Some industry sources estimate that less than 25% of nursing facilities across the country currently meet the full scope of staffing standards laid out in CMS’ Final Rule due to a myriad of factors including labor shortages and increasing wage pressures. Indeed, the impact and cost of these staffing requirements will vary significantly by state. For example, CMS reported that at least one state will need to increase certain staff by nearly 96% to meet the minimum standards, while other states already meet the requirements.

Today, President Biden signed an executive order and published a presidential memorandum seeking to improve access to the health insurance markets created by the Affordable Care Act, reverse certain Trump Administration healthcare policies, and to protect access to reproductive health services. The action comes on the seventh business day since the administration took office, a day dedicated to addressing broad healthcare issues, as opposed to the more acute pandemic measures that were taken on days one and two. Although not sweeping policy changes, President Biden signals ownership of the Affordable Care Act, which he as President Obama’s vice president shepherded, and rings in a new era of leadership that seeks to strengthen the law rather than repeal and replace it. The following is a summary and link to each of today’s actions:

This summary of key lawsuits affecting managed care is provided by the Health Care Group of Crowell & Moring. If you have questions or need assistance on managed care law matters, please contact Chris Flynn, Peter Roan, or any member of the Health Care Group.

Troy Barsky, a Washington, D.C.-based partner in the firm's Health Care Group, explains recent legislation designed to repeal the sustainable growth rate (SGR) formula for physician reimbursement, as well as provisions echoing the fraud and abuse mandates in the Affordable Care Act. "This is a strong message from Congress that the focus on fraud and abuse is here today," Barsky said. "The bill was supposed to focus on physician payments, but…having a strong compliance program is vitally important if you continue to operate in this space."

Washington, D.C.-based Health Care Group partner, Troy A. Barsky, speaks with Report On Medicare Compliance regarding Medicare accountable care organizations (ACOs) receiving another year of relief from fraud-and-abuse laws with the recent extension of waivers from the Centers for Medicare & Medicaid Services (CMS) and the Health & Human Services Office of Inspector General. Barsky, a former director of the CMS Division of Technical Payment Policy, stresses the importance of ACOs needing to comply with the anti-kickback statuses of these waivers. "If they use the waivers, it's an area of compliance they need to pay attention to," Barsky continues, "It can trip you up."

Troy Barsky, a partner in the firm's Health Care Group, is interviewed by Modern Healthcare to discuss how government investigators are likely to start wielding the False Claims Act even more aggressively than in the past. Barsky says, "the Justice Department's willingness to pursue huge False Claims cases on physician compensation against hospitals is new. In fact, it has created a great deal of uncertainty among providers who also recognize various financial incentives from the [Centers for Medicare & Medicaid Services] that favor doctor-integration." Barsky is the former director of the CMS Division of the Technical Payment Policy, Chronic Care Policy Group.

This week’s episode features a deep dive on the President’s Executive Order, Eliminating Waste and Saving Taxpayer Dollars by Consolidating Procurement, which directs the consolidation of certain types of “domestic federal procurement” under the General Services Administration in an effort to “eliminate waste and duplication.”  This episode is hosted by Peter Eyre and Yuan Zhou. Crowell & Moring's "Fastest 5 Minutes" is a biweekly podcast that provides a brief summary of significant government contracts legal and regulatory developments that no government contracts lawyer or executive should be without.

In this episode, Joe Records and Payal Nanavati talk to Scott Douglas and Charlotte Freed about the mental health provisions in the federal gun safety legislation. The new law included billions in federal funds to support mental health care—a huge investment likely to have major impacts on the industry.