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 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 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
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
/ Administrative Appeals ,
Amended Rules ,
Centers for Medicare & Medicaid Services (CMS) ,
Final Rules ,
Health Care Providers ,
Healthcare ,
Medicare ,
Medicare Part A ,
Medicare Part B ,
Medicare Part D ,
Prescription Drugs
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 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
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
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 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 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
On September 22, 2016, the United States District Court for the Middle District of Florida granted defendant hospice providers’ motions to dismiss plaintiff-relator’s claims under the False Claims Act, Florida’s False Claims...more
On August 19, 2016, the United States District Court for the District of Columbia granted a group of hospitals’ motion for summary judgment against HHS in a challenge of the Provider Reimbursement Review Board’s (PRRB) denial...more
8/24/2016
/ Administrative Proceedings ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Exhaustion Doctrine ,
Hospitals ,
Jurisdiction ,
MACs ,
Medicare ,
Outlier Payments ,
Provider Reimbursement Review Board ,
SCOTUS ,
Summary Judgment