Albert Shay

Albert Shay

Morgan Lewis

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Preparing for an ACA Rollback: How to Get Paid for Treating the Uninsured - Hospital Industry Viewpoint

Given that Republicans will soon control both Congress and the White House, hospitals may be concerned that expenditures that have helped reduce the ranks of the uninsured will be ratcheted down. However, forward-thinking...more

11/10/2016 - ACOs Affordable Care Act CMMI Donald Trump Healthcare Hospitals Life Sciences Medicaid Expansion

Provider-Based Rule and Stark—Is Joint Compliance Impossible in 2017?

The Centers for Medicare & Medicaid Services (CMS) will be putting hospitals in an untenable position if recent proposed rulemaking is implemented as is. In its proposal for acting on legislation reducing payments to new,...more

8/9/2016 - Alternative Fee Arrangements Bipartisan Budget Act CMS Fair Market Value False Claims Act (FCA) Hospitals Off-Campus Departments Physician Fee Schedule Physicians Stark Law

Senate Finance Committee Examines Repeal of the Stark Law

A new report suggests that the Stark law is obsolete in new payment models. On June 30, the US Senate Committee on Finance (the Committee) released the report Why Stark, Why Now? Suggestions to Improve the Stark Law to...more

7/7/2016 - Affordable Care Act AHLA Alternative Payment Models (APM) Anti-Kickback Statute Civil Monetary Penalty False Claims Act (FCA) Fraud Abuse and Waste Health Care Providers Legislative Agendas Medicare Medicare Access and CHIP Reauthorization (MACRA) Physicians Repeal Stark Law

The 60-Day Rule Is Final: Assessing Your Organization’s Safeguards

Follow these tips to ensure compliance in the wake of the new 60-Day Rule. On February 12, the CMS finalized the 60-Day Overpayment Report and Refund rule (60-Day Rule) for Medicare Parts A and B. This long-awaited rule...more

2/17/2016 - 60-Day Rule CMS Final Rules Medicare Part A Medicare Part B Overpayment Social Security Act

CMS Finalizes 60 Day Overpayment Rule

The final rule relaxes the requirements on “identification” and look-back period. The Centers for Medicare & Medicaid Services (CMS) has released its long-awaited final rule related to the reporting and refunding of...more

2/12/2016 - 60-Day Rule Affordable Care Act CMS Final Rules Medicare Part A Medicare Part B Overpayment Reporting Requirements

Stark Law Clarifications Bring Both Benefits and Potential Challenges - Hospital Industry Viewpoint

The new clarifications suggest a more lenient CMS, but providers shouldn’t compromise their compliance standards. Throughout the halls of hospitals’ legal and compliance departments, people have been talking....more

12/9/2015 - Amended Regulation CMS Hospitals Physician Compensation Arrangements Self-Referral Stark Law

New Budget Bill May Signal End of Provider-Based Status

Hospitals that seek to establish provider-based OPDs should complete their work soon. A near-final discussion draft of a House budget bill, which the White House has apparently agreed to in principle, would end the...more

10/29/2015 - Billing Drug Pricing Federal Budget Health Care Providers Healthcare Hospitals Pending Legislation Section 340B

CMS Releases 2016 Physician Fee Schedule

Major changes to Stark law are ahead, including new exceptions for timeshare arrangements and employment of NPPs. The Centers for Medicare & Medicaid Services (CMS) released a proposed rule on July 8 for the 2016...more

7/10/2015 - ACOs Alternative Payment Models (APM) Client Referrals CMS Comment Period Exceptions FQHC Healthcare Hospitals Medicaid Medicare Physician Fee Schedule Physicians Proposed Regulation Rural Health Care Providers Stark Law

The Three “Hows” Of Physician Compensation

New care delivery models and healthcare reimbursement trends are heating up the market for hospital employment of physicians yet again, but does a productivity-based compensation model still work in this environment?...more

3/18/2015 - Compensation Standards Fair Market Value Healthcare Hospitals Physician Medicare Reimbursements Physicians Stark Law

The OIG Work Plan: Does OIG Always Know Best?

Provider Compliance Departments routinely set audit priorities based, in part, on OIG’s Work Plan, but what should a provider do if it disagrees with a position that the OIG takes? Providers should be prepared to defend their...more

12/3/2014 - Audits Chief Compliance Officers Compliance Hospitals OIG Work Plans

HHS OIG Issues Revised Self-Disclosure Protocol

OIG touts substantial benefits of disclosing, provides greater detail for different types of disclosures, and captures 15 years of OIG Self-Disclosure Protocol experience....more

4/18/2013 - Anti-Kickback Statute Damages HHS OIG Self-Disclosure Requirements Stark Law

Protections to Be Extended for Electronic Health Record Donations

CMS and OIG issue similar proposed rules to modify the electronic health record exception and safe harbor. On April 10, the Centers for Medicare & Medicaid Services (CMS) and the Office of Inspector General (OIG) of...more

4/17/2013 - CMS EHR Final Rules OIG Proposed Amendments Safe Harbors

Final Sunshine Act Arrives: Now the Hard Part

The Centers for Medicare and Medicaid Services (CMS) issued the final regulations on the U.S. Sunshine Act on February 8, 2013. Transparency Reports and Reporting of Physician Ownership or Investment Interests, 78 Fed. Reg....more

3/8/2013 - Affordable Care Act CMS Healthcare Manufacturers Medical Devices Pharmaceutical Industry Physicians Reporting Requirements Sunshine Act

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