Hospital Price Transparency: New CMS Enforcement Measures, Increased Penalties, and Ensuring Compliance

Ms. Shalom focuses on counseling clients in the health care, pharmacy, and medical device industries with respect to a wide range of regulatory and compliance matters. Her experience includes advising clients on Medicare and Medicaid reimbursement; internal investigations; managed care and value based payment arrangements; self-disclosures; federal and state fraud and abuse compliance; and state licensure issues. She also assists health care clients with a broad range of transactional matters, including mergers and acquisitions and formation of friendly professional corporations.

Ms. Worthen provides legal and strategic advice to hospitals, health systems, physician practices, and behavioral health providers, as well as post-acute care and other ancillary providers. She has broad experience working on matters pertaining to Medicare reimbursement, participation in CMS Innovation Center payment models, managed care contract negotiations, and value-based payment arrangements with insurance companies, self-insured employers, and Medicare Advantage plans. She also provides counsel on the regulatory, operational, and financial considerations necessary to navigate the evolving payment landscape, including the various components of risk, ranging from pay for quality, to shared risk, and ultimately to full risk. Ms. Worthen also addresses privacy and security issues under HIPAA and the Part 2 regulations and assists providers with payment disputes under their managed care contracts.

Ms. Hoffmann serves clients in the healthcare industry on an array of regulatory, operational, and transactional matters. She regularly assists hospitals, healthcare systems, and other provider types with mergers and acquisitions, particularly in connection with the complex licensure and regulatory questions that can arise in the context of a transaction. Ms. Hoffmann also advises healthcare clients on Medicare and Medicaid certification, compliance, and payment matters, as well as out-of-network balance billing laws and other issues affecting provider payment. She has experience helping clients with a variety of state and federal regulatory requirements, including facility licensure and the certificate of need application process. Ms. Hoffmann is an adjunct professor at Belmont University College of Law, where she teaches Biomedical Ethics.