News & Analysis as of

Audits Patient Protection and Affordable Care Act (PPACA)

The Rise of Managed Care Audits and Reimbursement Demands in the Wake of the ACA

If the summer of 2017 demonstrated anything, it is that health care remains a complex and contentious industry. One of its many complications stems from the natural tension between health care providers and health care...more

SuperVision - Labor & Employment Law Insights - September 2017

...This issue of SuperVision is dedicated to questions our friends and clients may have regarding insurance and benefit topics. While not a common part of the Labor & Employment field, Spilman prides itself on having...more

Some Recent Tax Developments

by Pessin Katz Law, P.A. on

Over the past several months there have been a number of tax developments that might affect PK Law readers...more

501(r) Audits Are Here: What You Need to Know

by Nilan Johnson Lewis PA on

The Affordable Care Act imposed new requirements on tax-exempt hospitals under Section 501(r) of the Internal Revenue Code. Section 501(r) and its implementing regulations present a complex framework intended to promote...more

IRS Implementation of ACA’s Employer Shared Responsibility Provision Falls Short Based on the Results of a Recent Audit

by McDermott Will & Emery on

Based on a recent audit conducted by the Treasury Inspector General for Tax Administration (TIGTA), the IRS’ processes and procedures to ensure compliance with the employer information reporting requirements mandated by the...more

IRS Implementation of ACA’s Employer Shared Responsibility Provision Falls Short Based on the Results of a Recent Audit

by McDermott Will & Emery on

Based on a recent audit conducted by the Treasury Inspector General for Tax Administration (TIGTA), the IRS’ processes and procedures to ensure compliance with the employer information reporting requirements mandated by the...more

DOL Health & Welfare Plan Audit Response and Protection: Reducing Risk Exposure to Avoid Costly Penalties

by McDermott Will & Emery on

In a recent presentation, McDermott attorneys discussed how to prepare responses for a Department of Labor (DOL) investigative audit of a company’s health and welfare plan, including required documentation and procedures, DOL...more

OIG Expands Exclusionary Authority

The Department of Health and Human Services, Office of Inspector General (OIG) published a final rule on January 12, 2017, expanding the OIG’s authority to exclude providers from participation in federal healthcare programs....more

Health Care E-Note - January 2017

by Burr & Forman on

On October 4, 2016, The Centers for Medicare and Medicaid Services ("CMS") released the final rules regarding the requirements of participation for skilled nursing facilities. One of the most significant changes to the...more

What Employment Law Changes Should We Expect From the Trump Administration? Ask the Magic 8 Ball

by Garvey Schubert Barer on

If you had asked me one month ago to predict the winner of the presidential election, I would have been wrong. Therefore, rather than make my own [ill-fated] predictions of the changes that await employers when PEOTUS takes...more

As Affordable Care Act Enforcement Looms, Some Lessons Learned From Massachusetts

As the ACA audit era approaches, many employers are wondering: what will happen? What sorts of documentation will the IRS request? What industries will be targeted? And what can employers do to prepare? In this post, I...more

Have You Reviewed your Employee Handbook for Affordable Care Act Compliance?

Even though the first year of the Affordable Care Act’s employer mandate is in effect and fully phased-in, it has been our experience that few employers have bothered to review their employee handbooks to reflect the ACA. ...more

The Force Awakens on 2016

by Bryan Cave on

The ball dropped on 2016, but don’t drop the ball on your benefit plan compliance. As part of our annual tradition, we’re pleased to present this year’s Top Ten New Year’s Countdown for the reading pleasure of our fellow...more

Bipartisan Budget Agreement Triggers New Audit Rules for Partnerships; Repeals ACA Automatic Enrollment

by Williams Mullen on

On November 2, 2015, President Obama signed into law the Bipartisan Budget Agreement of 2015, H.R. 1314, which, in addition to lifting mandatory spending caps and raising the federal debt ceiling, has repealed the Affordable...more

Potential Penalties Creating Adjustments to Health Care Coverage Plan Offerings

by Locke Lord LLP on

What ACA-related issues have had the most impact on welfare benefit plans and may surface during 2016? JRN: 2015 is the year when the potential to be penalized for not offering employee health care coverage that is both...more

Employee Benefits Alert - August 2015

by Franczek Radelet P.C. on

Retirement Plans - IRS Issues Guidance on Benefit Suspension Voting under MPRA - As we have written in prior alerts, the Multiemployer Pension Reform Act of 2014 (MPRA) permits trustees of financially troubled...more

Week in Review – June 2015

Special Session – Not Yet - Governor Mark Dayton and House Republican leaders on Monday tentatively agreed to a two-year school spending budget, moving them one step closer to avoiding a partial government shutdown...more

Blog: HHS OIG Hands Out 2015 Work Plan For Halloween

by Cooley LLP on

On Friday October 31, 2014, the U.S. Department of Health & Human Services (HHS) Office of Inspector General (OIG) released its annual “Work Plan” for fiscal year 2015. The Work Plan is a compilation of the OIG’s plans for...more

Scripts Newsletter - October 2014

by Poyner Spruill LLP on

In this issue: - Health Care Decisions — Who Decides? - Medical Software Licensing — Tips from the Trenches - An Ounce of Prevention — The Importance of Periodic Corporate Audits - ACA -...more

Proposed Expansion of OIG’s Exclusion Authority

by Cozen O'Connor on

In May, the Office of Inspector General of the Department of Health and Human Services (OIG) proposed a new rule (Rule) that would implement changes included in the ACA. The Rule would expand OIG’s authority to exclude...more

CMS Changes to Medicare Advantage and Prescription Drug Benefit Programs for Contract Year 2015

by Ropes & Gray LLP on

On May 19, 2014, the Centers for Medicare & Medicaid Services (“CMS”) issued a final rule, published in the Federal Register on May 23, 2014, that sets forth changes to requirements for Medicare Advantage (“MA”) and...more

Health Care in 2014: A Brave New World

by Pepper Hamilton LLP on

With the completion of the enrollment phase of the Affordable Care Act (ACA), health care in the United States has entered a new era that will be characterized by extensive changes and challenges for both providers and...more

Health Headlines: Also in the News - May 2014

by King & Spalding on

OIG Reports Jurisdiction H Contractors Made $3.3 Million in Overpayments for Outpatient Drugs – According to a recent OIG report, the Medicare Contractors for Jurisdiction H overpaid providers approximately $3.3...more

340B Drug Pricing Program Update: Hospital Recertification and Recent Audit Activity

by Foley & Lardner LLP on

As part of its expanded authority resulting from the Patient Protection and Affordable Care Act (PPACA), the Health Resources and Services Administration (HRSA) is continuing its efforts to ensure compliance with 340B Drug...more

HRSA Clarifies 340B Orphan Drug Exception But 340B Audit Enforcement Remains Murky

Recently, HRSA publicly announced the issuance of a final rule clarifying when 340B covered entities can purchase and distribute orphan drugs through the 340B Drug Pricing Program. Separately, HRSA quietly posted a report on...more

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