On May 24 the District Court for the District of Columbia rejected an appeal brought by a group of urologists (“CUI”) seeking to overturn regulations promulgated in 2008 by the Centers for Medicare & Medicaid Services (“CMS”)...more
In this issue: - What’s Up With Nursing Facility “Mandatory” Corporate Compliance Programs? - Updated OIG Exclusion Guidance Spells Out Recommended Employee Screening Procedures - General Assembly Calls...more
New marketing integrity and oversight provisions warrant review and comment. On June 14, the Centers for Medicare and Medicaid Services (CMS) in the U.S. Department of Health and Human Services (HHS) published its...more
Last week the House Committee on Ways & Means Health Subcommittee held a hearing on Medicare overhaul proposals affecting post-acute care; the Congressional Budget Office (CBO) wrote to House Budget Committee Chairman Paul...more
In This Issue: Leading the News; Other HHS and Federal Regulatory Initiatives; Other Congressional and State Initiatives; Other Health Care News; and Hearing and Mark-Ups Scheduled. Excerpt from Leading the News...more
After 34 years, a federal district court in Florida has overturned a 1979 injunction which prevented the Centers for Medicare and Medicaid Services (CMS) from releasing to the public Medicare data related to physician billing...more
The United States Senate and House of Representatives recently introduced bipartisan legislation designed to reduce fraud, waste, and abuse in the Medicare and Medicaid programs. The legislation, entitled “Preventing and...more
CMS released on June 3, 2013, county-level data on Medicare spending and utilization, which, according to a corresponding press release, marks the first time the agency has made this information public. ...more
Bill Mathias of Ober|Kaler's Health Law Group presented on compliance as a part of the 2013 Healthcare Fraud and Abuse Bootcamp Webinar Series sponsored by the American Health Lawyers Association. This webinar...more
CMS has released its proposed federal fiscal year (FFY) 2014 prospective payment system (PPS) rule for Medicare Skilled Nursing Facilities (SNFs). The rule projects a net increase in operating payments to SNFs in the amount...more
CMS continues to expand its enforcement efforts in the enrollment area. Proposed regulations titled, “Medicare Program; Requirements for the Medicare Incentive Reward Program and Provider Enrollment”, were published on April...more
Discussions around reforming Medicare’s sustainable growth rate (SGR) continued this week as the Committee on Energy & Commerce held a hearing to solicit input on a draft bill for replacing the current SGR formula...more
Once again, the staff of the Federal Trade Commission (“FTC”) has rebutted claims by physician groups that state legislation is needed to allow independent physicians to collaborate....more
In this issue: - Best Patent Practices Under the America Invents Act - CMS Issues Final Rule for Implementing Sunshine Act - New IP Litigation Team a Boon for Firm's Life Sciences and Technology Clients -...more
On May 29, 2013, CMS issued a Proposed Decision Memorandum (the Memorandum) for reconsideration of its coverage of single-chamber and dual-chamber implanted permanent cardiac pacemakers under a National Coverage Determination...more
On May 23, 2013, CMS issued its Final Rule on Medical Loss Ratio (MLR) requirements for Medicare Advantage (MA) and Medicare Part D programs. MLR calculates the percentage of revenue used by MA organizations and Part D...more
A June 3, 2013 letter from CMS Administrator Marilyn Tavenner to Rep. Pete Sessions (R-Tex.) states that the agency does not believe it has any discretion under the Budget Control Act of 2011 to exempt Part B cancer drug...more
In This Issue: Leading the News; Implementation of the Affordable Care Act; Other HHS and Federal Regulatory Initiatives; Other Congressional and State Initiatives; Other Health Care News; and Hearings and Mark-Ups...more
In This Issue: - Top News ..CMS Finalizes MLR Rule for Plans, Maintaining Application to Part D Sponsors ..Early State Filings Show Premium Reductions under ACA ..HHS Received More Than 830 Letters of...more
The OIG recently issued a report (A-01-12-00507) concerning the potential financial impact to Medicare Part A if CMS established a hospital transfer payment policy for early discharges to hospice care. The OIG explained that...more
Medicare Trustees released their annual report finding that the Medicare trust fund will be exhausted in 2026, two years later than was predicted last year; over the past two weeks, as Washington has investigated the Internal...more
In This Issue: Implementation of the Affordable Care Act; Other HHS and Federal Regulatory Initiatives; Other Congressional and State Initiatives; Other Health Care News; and Hearings and Mark-Ups...more
The OIG issued a report titled “Improvements Needed to Ensure Provider Enumeration and Medicare Enrollment Data Are Accurate, Complete, and Consistent,” in which it details multiple failings in the reliability of the data...more
The Centers for Medicare & Medicaid Service’s release of the final Medicare medical loss ratio regulations allows Medicare Advantage Organizations and Part D Plan Sponsors to evaluate their operations in order to come into...more
As soon as the Supreme Court released its decision regarding the optional nature of the Affordable Care Act's (ACA) Medicaid expansion provision in June 2012, the hospital industry became concerned over the law's imposed...more
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