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On March 23, 2010 President Obama signed into law the comprehensive health care overhaul known as the Patient Protection and Affordable Care Act ("PPACA"), Pub. Law 111-148[1]. This wide-ranging law has far reaching implications on the financing and delivery of health care in the United States. In addition, it contains substantial changes to federal health care program requirements, including health care fraud and abuse provisions.

Numerous lawsuits have challenged the constitutionality of the law, in particular the mandate that otherwise uninsured individuals purchase a health insurance policy with a minimum benefit package. The U.S. Supreme Court agreed to consider three consolidated cases from the Eleventh Circuit Court of Appeals. The cases challenged the constitutionality of the individual insurance mandate and the constitutionality of the Medicaid expansion imposed on state governments as a condition of receiving federal Medicaid matching dollars. In a June 28, 2012 judgment, the Supreme Court determined that the individual mandate to purchase insurance is constitutional under the taxing power of Congress. The court also decided that Congress could not mandate Medicaid expansion on the states by threatening loss of all federal Medicaid funds. Instead, if a state chooses to implement the expansion, it will receive the federal funds set forth in the amounts stated in the PPACA. If a state chooses not to expand, it will not receive the federal funds for expansion but it will not lose federal funds for its existing Medicaid program.

The list below includes topics and publication dates for a series of K&L Gates client alerts directed to the health care provider and supplier community that are focused on particular implications of PPACA as to the payment and regulation of health care providers and suppliers.  Please click on the Publications link on the right of this page to view these alerts.

  • New Inducements to Beneficiaries Exceptions
  • New Disclosure and Reporting Requirements Related to Manufacturers and GPOs Payments to Teaching Hospitals and Physicians
  • New Requirements on Charitable Hospitals
  • Liability for Failure to Disclose and Return "Identified" Overpayments
  • Changes in Graduate Medical Education Funding and Reimbursement
  • New Mandated Nursing Facility Reporting of "Additional Disclosable Parties"
  • Revisions to Medicare and Medicaid Provider/Supplier Enrollment and Billing Requirements
  • Expansion of the 340B Drug Pricing Program
  • Revisions to the Stark Law and Stark Regulations: Exceptions for In-Office Ancillary Services and Physician Owned Hospitals
  • Two New Cost Containment Measures: Medicare Shared Savings Program and National Pilot Program on Payment Bundling
  • CMS Issues Physician Self-Referral Disclosure Protocol
  • IRS Releases Guidance on Community Health Needs Assessment Requirements for Charitable Hospitals.
  • CMS Bundled Payments Initiative

[1] On March 30, 2010, President Obama signed the reconciliation bill (H.R. 4872, the “Health Care and Education Reconciliation Act of 2010” or “Reconciliation Bill”), which amended PPACA.