Health Care Providers

News & Analysis as of

MACRA: Program Integrity and Fraud and Abuse Provisions

On Thursday April 16th, President Obama signed into law the Medicare Access and CHIP Reauthorization Act of 2015 (“MACRA”). Pub.L. 114-10. In two previous posts, we discussed MACRA’s repeal of the Sustainable Growth Rate...more

Health Law Alert: OIG Issues New Practical Guidance for Board Oversight of Compliance Programs

On April 20, 2015, the U.S. Department of Health and Human Services Office of Inspector General (OIG), in conjunction with several healthcare associations, published a useful new compliance document titled “Practical Guidance...more

Data Breach Class Actions: Don’t Overlook Standing Defense Just Because Plaintiff Alleges Identity Theft

A New Jersey federal district court recently dismissed the putative class action claims of four plaintiffs against a health care defendant following the theft of two password-protected laptops allegedly containing personal...more

OIG Issues Compliance Guidelines for Governing Boards

On April 20, 2015, the Office of Inspector General (OIG) of the Department of Health & Human Services issued new compliance guidance for governing boards of hospitals and other health care organizations....more

Office of Inspector General Governance Guidance

On April 20, the Department of Health and Human Services Office of Inspector General (OIG), in conjunction with the Association of Healthcare Internal Auditors, American Healthcare Association and Health Care Compliance...more

Passage of Medicare Access and CHIP Reauthorization Act of 2015 (MACRA): The “Doc Fix”

The President has signed into law the bipartisan bill H.R. 2, the “Medicare Access and CHIP Reauthorization Act of 2015,” which permanently repeals the flawed Sustained Growth Rate (SGR) formula and replaces it with a stable...more

HHS OIG Issues Guidance to Healthcare Boards Regarding Oversight

On April 20, 2015, the United States Department of Health and Human Services Office of the Inspector General (OIG) issued guidance aimed at the governing boards of healthcare entities. The guidance—issued in conjunction with...more

Permanent “Doc Fix” Legislation Substitutes Merit-Based Incentive Payment System for SGR, and Contains Other Reimbursement and...

In addition to finally repealing the so-called sustainable growth rate methodology (“SGR”) for adjusting Medicare physician payments that Congress has overridden consistently since 2004, the newly enacted Medicare Access and...more

Following FDA’s First Biosimilar License, CMS Issues Guidance on Reimbursement for Biosimilars

On March 6, 2015, FDA released a statement announcing its issuance of the first biosimilar license to Zarxio. In the same month, CMS issued a number of guidance documents addressing reimbursement for biosimilars under the...more

OIG Partners with Industry Associations by Issuing Practical Guidance for Health Care Governing Boards on Compliance Oversight

On April 20, 2015, the Office of the Inspector General of the Department of Health and Human Services (“OIG”) released educational guidance designed to assist governing boards of health care organizations (“Boards”) in their...more

Are You in Compliance? Effect of Exclusion from Participation in Medicare and Medicaid

The Office of Inspector General’s (“OIG”) recent release of OIG Advisory Opinion No. 15-02 is an important reminder that providers must be vigilant in complying with prohibitions against receiving payment for items or...more

Polsinelli Podcasts: Cloud Computing, From Cybersecurity to Confidentiality Issues [Video]

Hosting and securing data is a concern for both businesses and consumers. As companies and health systems are quickly adopting the idea of hosting data “in the cloud,” regulatory agencies are crafting laws to protect private...more

How New York’s Emergency Medical Services and Surprise Bills Law Impacts Providers and Plans

Last year New York passed legislation known as the “Emergency Medical Services and Surprise Bills” law, a much-heralded consumer protection law primarily intended to guard against surprise bills for out of network (OON)...more

Beyond SGR – MACRA Provides Additional Payment Provisions and Offsets

This is the second post in our continuing series on the Medicare Access and CHIP Reauthorization Act (MACRA). Pub.L. No: 114-10. In addition to repealing the Sustainable Growth Rate (SGR), which was covered in our April 20th...more

Pharmacists: Aren’t you really providers already? – Part One

While the passage of the Patient Protection and Affordable Care Act (“ACA”) ushered in a new era of access to health care, it only served to exacerbate a growing crisis in the provision of health care – lack of providers....more

OIG Releases Joint Guidance for Health Care Boards

Yesterday, the Office of Inspector General (“OIG”) published “Practical Guidance for Health Care Governing Boards on Compliance Oversight.” The guide is intended as an educational resource for the boards of healthcare...more

New Guidance for Health Care Boards

On Monday, April 20th the U.S. Department of Health and Human Services Office of Inspector (HHS OIG) announced new compliance guidance that impacts health care providers across the country....more

New Board Compliance Guidance Prompts General Counsel Focus

Health care general counsel should review, and brief their internal clients on, the new Practical Guidance for Health Care Governing Boards on Compliance Oversight (Guidance), released on April 20, 2015. A joint effort by...more

What Makes A Five Star Hospital?

The Affordable Care Act includes many provisions aimed at improving the quality of care provided by different types of health care professionals and providers. Along these lines, the ACA expands the types of facilities and...more

CMS Reschedules Call on Home Health Clinical Templates (April 28)

On April 28, 2015, CMS is hosting its final call to discuss paper and clinical templates intended to assist physicians and practitioners in documenting patient eligibility for Medicare home health benefits. ...more

Mississippi CON Report

In this Issue: - I. March 2015 – Mississippi Certificate of Need Meeting - II. Certificate of Need Program Report – Filings/Reports in March 2015 - A. Letters of Intent to Change Ownership - B....more

New Medicare Law Advances Gainsharing

On April 16, 2015, President Obama signed into law H.R.2, the Medicare Access and CHIP Reauthorization Act of 2015 (the "Act"), which provides for sweeping changes to how Medicare pays doctors. Specifically, the Act seeks to...more

With SGR Repealed, Replacement Policy Creates New Priorities

On April 16, 2015, President Obama signed into law, the “Medicare Access and CHIP Reauthorization Act of 2015” (MACRA), ending annual temporary patches and massive lobbying efforts since the late 1990s to prevent significant...more

Blog: OIG Releases New Guidance for Board Oversight of Corporate Compliance Programs

Yesterday, the U.S. Department of Health and Human Services Office of Inspector General (OIG), in conjunction with the American Health Lawyers Association (AHLA), the Association of Healthcare Internal Auditors (AHIA) and the...more

SGR Law Brings Changes to CMP Prohibition on Gainsharing

On April 16, President Barack Obama signed into law the “Medicare Access and CHIP Reauthorization Act of 2015,” ending a perennial struggle over the Medicare reimbursement formula for physicians. Although the law is most...more

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