John Tilton

Feb 29, 2024 | natlawreview.com | John Tilton

The United States District Court for the Eastern District of Virginia recently dismissed an appeal by the Pharmaceutical Coalition for Patient Access (“PCPA”) that challenged a negative opinion issued by the U.S. Department of Health and Human Services, Office of the Inspector General (“OIG”) concerning pharmaceutical manufacturers’ offers of cost-sharing subsidies to Medicare Part D (“Part D”) beneficiaries.

Feb 28, 2024 | lexblog.com | John Tilton |Michael Sutton

The United States District Court for the Eastern District of Virginia recently dismissed an appeal by the Pharmaceutical Coalition for Patient Access (“PCPA”) that challenged a negative opinion issued by the U.S. Department of Health and Human Services, Office of the Inspector General (“OIG”) concerning pharmaceutical manufacturers’ offers of cost-sharing subsidies to Medicare Part D (“Part D”) beneficiaries.

Nov 21, 2023 | coastalview.com | John Tilton

For more than half a century, Carpinterians have been actively working to preserve the Carpinteria Bluffs properties as open space for the community to enjoy. We have spoken loudly and clearly with voices, votes (such as Measure J, the Paredon project, which would have had a major impact on the bluffs) and hard-earned dollars (in purchasing two parcels so far to keep them as open space).

Sep 28, 2023 | jdsupra.com | Christine M. Clements |John Tilton

The Centers for Medicare & Medicaid Services (“CMS”) released the final rule on risk adjustment data validation (“RADV”) audits of Medicare Advantage (“MA”) organizations (the “Final Rule”) on January 30, 2023. Among other changes, this Final Rule will allow CMS to audit a sample of an MA organization’s (“MAO”) diagnoses reported for risk adjustment purposes (from 2018 and later) and then use the audit findings to calculate an extrapolated improper payment amount for the MAO’s contract.

Sep 12, 2023 | jdsupra.com | Cynthia Suarez |John Tilton

On August 14, 2023, the Centers for Medicare & Medicaid Services (CMS) released guidance on changes to the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model starting in performance year 2024 (PY2024). The changes came about in response to stakeholder and participant feedback. All ACO REACH participants should familiarize themselves with the upcoming changes.