The Massachusetts legislative session officially closed on August 1, 2024 after an unusual half day extension. The 193rd legislative session left many omnibus bills unpassed, including S.B. 2881, “an Act enhancing the market...more
The Office of Inspector General (OIG) recently issued a new favorable advisory opinion regarding patient assistance programs (PAP) for 12 specific disease funds. PAPs help patients pay high cost-sharing obligations for...more
On April 23, 2024, the Federal Trade Commission (“FTC” or the “Commission”) voted to finalize a rule abolishing the vast majority of employee noncompetes across the United States (the “Noncompete Rule” or “Rule”). The FTC...more
4/25/2024
/ Department of Labor (DOL) ,
Employment Contract ,
Federal Bans ,
Federal Trade Commission (FTC) ,
Final Rules ,
FTC Act ,
Non-Compete Agreements ,
Non-Disclosure Agreement ,
Non-Solicitation Agreements ,
Notice of Proposed Rulemaking (NOPR) ,
Restrictive Covenants ,
Trade Secrets
Following public hearings and at least 78 public comments, at the end of October, hospitals and other facilities licensed by the Massachusetts Department of Public Health (DPH) will have new flexibility to require both flu...more
In connection with the November 2023 Health Care Compliance Association’s (HCCA) Healthcare Enforcement Compliance Conference, and with acknowledgment by the Chief Counsel to the Inspector General, Rob DeConti, of the long...more
11/8/2023
/ Advisory Opinions ,
Anti-Kickback Statute ,
Audits ,
Civil Monetary Penalty ,
Compliance ,
Corporate Integrity Agreement ,
Department of Health and Human Services (HHS) ,
Enforcement ,
Healthcare Fraud ,
OIG ,
Private Equity ,
Risk Assessment ,
Self-Disclosure Requirements
As part of the $1.7 million omnibus spending bill that became law December 29, 2022, the Centers for Medicare & Medicaid Services (CMS) extended, through December 31, 2024, the Acute Hospital Care at Home (H@H) initiative...more
On December 27, 2022, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule which, in part, seeks to amend the existing regulations for Medicare Parts A, B, C, and D regarding the standard for when an...more
1/3/2023
/ Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Civil Monetary Penalty ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Medicare Advantage ,
Medicare Part A ,
Medicare Part B ,
Medicare Part C ,
Medicare Part D ,
OIG ,
Overpayment ,
Proposed Rules
Workplace violence has become one of the key management challenges and sources of enterprise risk for hospitals over the past several years. Threats from patients, visitors, and staff have increased, sometimes with tragic...more
On Friday, December 2, 2022, the Centers for Medicare & Medicaid Services (CMS) issued an FAQ regarding the Good Faith Estimate (GFE) and Convening Provider/Facility requirements in the Federal No Surprises Act. The issued...more
The Office of Inspector General of the U.S. Department of the Health and Human Services (OIG) recently changed the language describing a compliance officer’s role in relation to other responsibilities he or she may have...more
Health care facilities and certain other nonprofits have new opportunities for Federal public assistance funds, but they must act quickly. On October 4, 2022, President Biden amended the Hurricane Ian Major Disaster...more
On July 5, 2022, the Commonwealth of Massachusetts re-extended the implementation and enforcement date for the “Patients First Act”, sometimes referred to as the Massachusetts No Surprises Act, to January 1, 2025. As...more
It has been almost two years since the Centers for Medicare & Medicaid Services (CMS) first issued blanket waivers of certain hospital conditions of participation allowing healthcare systems and hospitals to provide hospital...more
Academic Medical Centers (AMCs) are commonly known for providing communities across the globe with comprehensive patient care, extensive research programs, and educating our future healthcare providers. However, the high...more
Many hospital, health systems and other health care providers have seen benefits in sponsoring sports teams, stadiums and athletic tournaments. Considerations include general branding in the community, recruitment of staff or...more
2/10/2022
/ Advertising ,
Compliance ,
Corporate Branding ,
Fraud and Abuse ,
Health Care Providers ,
Healthcare ,
Healthcare Facilities ,
Hospitals ,
Marketing ,
Medicare ,
Reporting Requirements ,
Sponsors ,
Sponsorship Agreements
The Massachusetts Department of Public Health (DPH) has delayed the enforcement penalties for the new notice requirements under the “Patients First Law” until July 1, 2022. This news comes as a relief to the provider...more
On September 30, 2021, the U.S. Departments of Health and Human Services (HHS), Labor and Treasury (collectively, the Departments) along with the Office of Management and Budget released “Requirements Related to Surprise...more
Over the last several years, both the federal government and a number of state legislatures have sought to find a solution to the billing by out-of-network providers, referred to as “Out of Network Billing” (OON Billing) and...more
More than 900 hospitals across the United States are approaching a Centers for Medicare & Medicaid Services (CMS)-imposed deadline to report overpayments from the removal (explant) of defective cardiac medical devices if...more
On August 8, 2020 President Donald Trump issued four different executive actions in response to the breakdown in negotiations with congressional leaders over the next wave of economic stimulus programs designed to aid workers...more
COVID-19 has hit long-term care facilities very hard. Every day brings reports of lethal outbreaks in such facilities and one-quarter or more of the reported COVID-19 related deaths in the United States have been connected...more
As discussed in detail in a prior post, U.S. Health and Human Services Secretary Alex M. Azar II (the Secretary) issued blanket waivers of sanctions under the federal Physician Self-Referral Law (Section 1877 of the Act),...more
Massachusetts Governor Charlie Baker has restarted the discussion on health care cost containment in the Commonwealth with a proposed bill that contains a raft of initiatives. This is the first in a series of blog posts to...more
12/12/2019
/ Blue Cross ,
Blue Shield ,
Centers for Medicare & Medicaid Services (CMS) ,
Employer Group Health Plans ,
False Claims Act (FCA) ,
Fees ,
Governor Baker ,
Health Care Providers ,
Health Insurance ,
Healthcare Facilities ,
HMOs ,
Hospitals ,
Insurance Industry ,
Medicare ,
PPOs ,
Proposed Legislation ,
Site-Neutral Exception
The U.S. healthcare industry remains at a crossroads. The healthcare reform legislation passed under President Barack Obama in 2010, officially called the Patient Protection and Affordable Care Act (ACA) but widely referred...more
10/11/2019
/ Accreditation ,
Affordable Care Act ,
Anti-Kickback Statute ,
Centers for Medicare & Medicaid Services (CMS) ,
Certificate of Need ,
Civil Monetary Penalty ,
Co-Management ,
Corporate Practice of Medicine ,
Department of Health and Human Services (HHS) ,
Electronic Protected Health Information (ePHI) ,
False Claims Act (FCA) ,
HCQIA ,
Health Care Providers ,
Health Insurance ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Healthcare Facilities ,
Healthcare Reform ,
HMOs ,
Hospitals ,
HSA ,
Individual Mandate ,
Medicaid ,
Medical Certification Requests ,
Medical License ,
Medicare ,
Medicare Shared Savings Program ,
Nurses ,
Obama Administration ,
OIG ,
Outpatient Prospective Payment System (OPPS) ,
Physician-Owned Hospitals ,
Preexisting Conditions ,
Stark Law ,
Trump Administration ,
Value-Based Care
On September 17, 2019, the D.C. District Court held that the Centers for Medicare & Medicaid Services (CMS) exceeded its statutory authority when it cut the payment rate for clinic services at off-campus provider-based...more