January 2018
340B Litigation Update: Hospitals Must Take Steps to Comply with Final Rule

Significant Medicare Part B reimbursement rate cuts and burdensome claim modifiers apply to certain drugs purchased by hospitals through the 340B drug discount program effective on Jan. 1, 2018 after a federal judge declined to hear a case brought by 340B stakeholders. Read the opinion here and Polsinelli’s analysis of CMS’s 2018 OPPS payment adjustment rule (Final Rule) here.

The Court’s ruling arrives on the heels of Congress’s recent repeal of the Affordable Care Act’s individual insurance coverage mandate. In aggregate, these two developments could increase pressure on safety net hospitals’ bottom lines as they provide more uncompensated care while facing reduced payment rates and burdensome claim submission requirements. As a result, 340B hospitals need to assess their existing billing processes and implement modifiers to avoid overpayment and False Claims Act risks.

This update explores the recent ruling by the DC District Court, the fate of future legal challenges to CMS’s payment reduction, and what all 340B-participating hospitals need to do to comply with CMS’s Final Rule. 

To read the full e-alert, click here.