Susan Edwards

Susan Edwards

Reed Smith

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CMS Adopts Final SNF PPS Rates and Policies for FY 2017

CMS has published its final rule to update Medicare skilled nursing facility (SNF) PPS rates and policies for FY 2017. CMS projects that the final rule will increase overall payments to SNFs by $920 million, or 2.4%, compared...more

8/2/2016 - CMS IMPACT Act Inpatient Quality Reporting Medicare Skilled Nursing Facility

Bigger Apparently is Better in DOJ’s Eyes – DOJ Piles On as False Claims Act CMPs Set to Almost Double on August 1, 2016

On June 30, 2016, the Department of Justice published an interim final rule with request for comments that applies an inflation adjustment to civil monetary penalty (CMP) amounts assessed by the Department, as mandated by the...more

6/30/2016 - Bipartisan Budget Civil Monetary Penalty Comment Period Corporate Counsel DOJ False Claims Act (FCA) Health Care Providers Interim Rule Manufacturers Suppliers

CMS Finalizes “Comprehensive Care for Joint Replacement” Model

On November 16, 2015, CMS released its final rule to establish a Medicare Comprehensive Care for Joint Replacement (CJR) model that will test whether bundled payments to acute care hospitals for lower extremity joint...more

11/17/2015 - Bundled Payments CCJR CMS Final Rules Hospitals Medicare

Bipartisan Budget Act Jacks Up Civil Monetary Penalties Under the Social Security Act and False Claims Act Penalties

The Bipartisan Budget Act of 2015 (H.R. 1314), signed into law by President Obama November 2, 2015, will increase the civil monetary penalties (CMPs) imposed under the Social Security Act (SSA) in addition to False Claims Act...more

11/12/2015 - Bipartisan Budget Civil Monetary Penalty False Claims Act (FCA) Inflation Adjustments Social Security Act

HHS OIG “Reminder” about Information Blocking & the Federal Anti-Kickback Statute

The HHS Office of Inspector General (OIG) recently released a “Policy Reminder” on how “information blocking” — defined by HHS as knowingly and unreasonably interfering with the exchange or use of electronic health...more

10/21/2015 - Advisory Opinions Anti-Kickback Statute Donors Electronic Medical Records Health Care Providers Health Information Technologies Healthcare HHS No-Blocking Rules OIG Policy Statement Safe Harbors

Analysis of HHS OIG Proposed Rule to Amend the Anti-Kickback Safe Harbors, CMP Rules on Beneficiary Inducements & Gainsharing...

On October 3, 2014, the Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) published a major proposed rule that would amend the safe harbors to the Anti-Kickback Statute (AKS) and the Civil...more

10/22/2014 - Affordable Care Act Ambulance Providers Anti-Kickback Statute CMP Law Gainsharing Hospitals OIG Pharmacies Physicians Proposed Regulation Public Comment Rulemaking Process Safe Harbors

OIG Proposes Rule to Implement Expanded Civil Monetary Penalty Authority under the ACA

The Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) has published a proposed rule that would amend the health care program civil monetary penalty (CMP) regulations (Proposed Rule)....more

5/21/2014 - Affordable Care Act Civil Monetary Penalty HHS OIG Pharmaceutical Industry Prescription Drug Coverage Prescription Drugs Proposed Regulation

President Signs Medicare Physician Fee Schedule/SGR Patch with Numerous Health Policy Provisions

In This Issue: - One-Year Medicare Physician Fee Schedule Fix - Valuation of Services Under the Physician Fee Schedule - ICD-10 Delay; LTCH Moratorium to Become Effective Immediately - Skilled Nursing...more

4/8/2014 - Barack Obama Long-Term Care Medicaid Medicare Physician Fee Schedule SNF

CMS and the OIG Extend Protections for Electronic Health Record Donations

On December 27, 2013, the Office of Inspector General (“OIG”) and the Centers for Medicare & Medicaid Services (“CMS”) each published, in the Federal Register, a final rule that amends regulations under the Anti-Kickback...more

1/24/2014 - Anti-Kickback Statute CMS EHR Healthcare OIG PHI Stark Law

Part B Inpatient Billing in Hospitals

Introduction - On March 13, 2013, the Centers for Medicare & Medicaid Services (CMS) concurrently issued CMS Ruling Number CMS-1455-R (the Administrator’s Ruling) and a proposed rule, “Part B Inpatient Billing in...more

4/8/2013 - CMS Hospitals Inpatient Billing Pending Legislation

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