Last week, CMS announced additional flexibilities that expand its Hospital Without Walls initiative, which provides broad regulatory flexibility that allows hospitals to provide services in locations beyond their existing...more
On August 17, 2020, CMS issued a Medicare Learning Network (MLN) Matters article providing that for admissions occurring on or after September 1, 2020, in order to be eligible for the 20 percent increase in the MS-DRG...more
On July 10, 2020, HHS announced over $4 billion in additional relief funding for certain hospitals impacted by the COVID-19 pandemic. The new round includes payments of approximately $3 billion to safety net hospitals and...more
On March 2, 2020, the Supreme Court of the United States granted certiorari to hear appeals in two cases concerning the constitutionality of the Affordable Care Act (ACA): California, et al. v. Texas, et al., Case No. 19-840...more
On January 23, 2020, HHS issued its final rule adopting a modification of the requirements for the use of the Telecommunication Standard Implementation Guide, Version D.0, National Council for Prescription Drug Programs...more
On December 12, 2019, OIG released a report finding that CMS made an estimated $94 million in incorrect Medicare incentive payments to acute-care hospitals for using electronic health records (EHRs) over an audit period from...more
Many contracts have provisions that state that disputes relating to the agreement will be resolved in arbitration. But often questions arise as to whether a particular dispute should be decided in arbitration or in court. ...more
On September 4, 2019, following remand from the Supreme Court’s decision in Azar v. Alina Health Services, No. 17-1484 (U.S. June 3, 2019), the United States District Court for the District of Columbia declined plaintiff...more
On May 3, 2019, CMS issued its final rule implementing changes to the appeal procedures for Medicare claims and Medicare prescription drug coverage determinations (the Final Rule). The Final Rule will be published in the...more
5/8/2019
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CMS recently issued a Medicare Learning Network (MLN) Matters article in connection with Change Request 11042 released on April 12, 2019 (the Change Request), which revises the Medicare Claims Processing Manual (Publication...more
A recent study by OIG found that a high number of claims denied by Medicare Advantage Organizations (MAOs) were overturned upon appeal and that CMS audits persistently found inappropriate claim denials. OIG is concerned that...more
On September 17, 2018, the DOJ released a statement announcing that it would be closing its investigation into Cigna Corporation’s (Cigna) $67 billion proposed acquisition of Express Scripts Holding Company (Express...more
On August 16, 2018, the DOJ announced that Lincare, Inc. (Lincare), a durable medical equipment (DME) provider of oxygen and other in-home respiratory therapy services, paid $5.25 million to settle allegations that it...more
On July 25, 2018, CMS proposed a rule (Proposed Rule) revising factors for determining Medicare payment rates for the Hospital Outpatient Prospective Payment System (OPPS) and the Ambulatory Surgery Center (ASC) Payment...more
On June 20, 2018, the DOJ announced that Healogics, Inc., a Florida-based operator of approximately 700 hospital-based wound care centers (Healogics), had agreed to pay up to $22.51 million to settle allegations that it...more
On February 16, 2018, the U.S. Attorney’s Office for the Northern District of Texas announced that the University of North Texas Health Science Center (UNTHSC) had agreed to pay $13,073,000 to the United States to settle...more
In public meetings held on January 11-12, 2018, Medicare Payment Advisory Commission (MedPAC) members voted to recommend that Congress maintain Medicare’s current updates for payments to providers for acute care hospital...more
On December 11, 2017, the United States District Court for the District of Columbia granted in part and denied in part defendant Boston Heart Diagnostics Corporation’s (Boston Heart) motion to reconsider the court’s ruling on...more
CMS recently issued a Medicare Learning Network (MLN) Matters article in connection with Change Request 10175 (issued August 11, 2017), which provides instructions for payment to Rural Health Clinics (RHCs) billing under the...more
On August 15, 2017, CMS announced a proposed rule to cancel the Episode Payment Models (EPMs) and Cardiac Rehabilitation (CR) incentive payment model scheduled to begin January 1, 2018, and to rescind the regulations...more
On June 21, 2017, the Federal Trade Commission (Commission) voted to close its investigation into whether the Texas Medical Board (TMB) violated federal antitrust laws by adopting rules that restricted the practice of...more
On May 19, 2017, HHS further delayed the effective dates concerning two final rules issued during the Obama administration. First, HHS delayed until October 1, 2017 the effective date of a January 5, 2017 final rule for the...more
On April 26, 2017, the United States District Court for the Middle District of Florida denied the government’s motion for leave to submit a “statement of interest” in a False Claims Act (FCA) action in which the government...more
On March 20, 2017, HHS issued an interim final rule further delaying until May 22, 2017, the effective date of a January 5, 2017, final rule for the 340B Drug Pricing Program that addresses the calculation of drug ceiling...more
On December 20, 2016, CMS issued its final rule implementing three new Medicare Parts A and B episode payment models for patients admitted for treatment for heart attack, bypass surgery, or hip/femur fracture under its...more