Leslie Demaree Goldsmith

Leslie Demaree Goldsmith

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Court Allows 'Retroactive' Application of 2005 Wage Index Rule Limiting Reimbursement for Pension Plan Costs

On February 22, 2016, in Regents of the University of California v. Burwell, the U.S. District Court for the District of Columbia granted summary judgment in favor of the Secretary of Health and Human Services (the Secretary)...more

3/21/2016 - Administrative Procedure Act Appeals GAAP HHS Hospitals Medicare Notice and Comment Pensions Provider Payments PRRB Retroactive Application Wage Index

Wage Index Reclassification Rule Struck Down by Second Circuit

On February 4, 2016, the United States Court of Appeals for the Second Circuit decided Lawrence + Memorial Hospital v. Burwell. The case addressed a regulation, issued by the Secretary of Health and Human Services...more

3/2/2016 - Chevron Deference Drug Pricing HHS Hospitals Medicare Reclassification Rules Rural Health Care Providers Wage Index

The Bad Debt Moratorium Requires a Flexible Approach to Evaluating "Reasonable Collection Efforts"

On September 10, 2015, District Judge Randolph D. Moss of the U.S. District Court for the District of Columbia issued an opinion in Mountain States Health Alliance v. Burwell (Mountain States) involving Section 310 of the...more

10/28/2015 - Administrative Procedure Act Audits Bad Debt Collection Agencies HHS Medicare Moratorium Provider Reimbursement Manual Provider Reimbursement Review Board Reasonable Collection Efforts Repeal Secretary of HHS

Uncertainty Continues for Two-Midnight Rule's Payment Reduction

In Shands Jacksonville v. Burwell [PDF], No. CV 14-1477, 2015 WL 5579653, (D.D.C. Sept. 21, 2015), the United States District Court for the District of Columbia gave the Secretary of the Department of Health and Human...more

10/14/2015 - Administrative Procedure Act HHS Hospitals Inpatient Billing Medicare Notice and Comment Provider Payments Rulemaking Process Secretary of HHS Two-Midnight Rule

"Next Generation" ACO Model Announced by CMS

In a March 10, 2015 press release, CMS announced a new addition to its existing Accountable Care Model (ACO) portfolio: Next Generation ACOs. As stated by CMS in its press release, this new ACO model will allow for already...more

4/9/2015 - ACOs Affordable Care Act CMS HHS Next Generation ACO (NGACO)

HHS to Continue Enforcing Orphan Drug Exclusion from 340B Program

The Department of Health and Human Services (HHS) through its Office of Health Resources and Services Administration (HRSA) announced last week that, although a court recently struck down its regulation addressing application...more

6/30/2014 - Covered Entities HHS HRSA Orphan Drugs Pharmaceutical Industry PHRMA Prescription Drugs Section 340B

Medicare Bad Debt: Courts Again Uphold HHS's Stringent "Must Bill" Policy Requirements

On March 25, 2014, the United States District Court for the District of Maine upheld the decision of the Department of Health and Human Services (HHS) to withhold from Maine Medical Center (MMC), Medicare reimbursement for...more

5/5/2014 - Healthcare HHS Medicare

OIG Calls for Increased Scrutiny on Hospital Outlier Payments

In a recent report [PDF], the Department of Health and Human Services Office of the Inspector General (OIG) highlighted hospital outlier payment trends it found troubling: Of the nearly 3,200 hospitals reviewed, approximately...more

11/27/2013 - Healthcare HHS Hospitals Inpatient Prospective Payment System (IPPS) Medicare OIG Outlier Payments

Expect Increased Medicare Denials for Incarcerated Beneficiaries and Unlawful Aliens

The Department of Health and Human Services’ Office of Inspector General (OIG) recently published two reports finding Medicare improperly paid providers millions of dollars for incarcerated beneficiaries and unlawful aliens...more

2/22/2013 - HHS Incarcerated Beneficiaries Medicare Medicare Claims Processing Manual OIG Unlawful Aliens

Court Again Rules Medicare’s “Must Bill” Policy for Medicare Dual Eligible Bad Debts Is Reasonable

The United States District Court for the District of Columbia once again upheld the decision of the Secretary of Health and Human Services (Secretary) to deny reimbursement for Medicare bad debts associated with copayments...more

12/5/2012 - HHS Medicaid Medicare

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