News & Analysis as of

Healthcare Compliance Centers for Medicare & Medicaid Services (CMS)

Proskauer - Health Care Law Brief

No Surprises Here!  CMS Audit Uncovers Non-Compliance by Aetna in Calculation and Disclosure Requirements Under the No Surprises...

In a recent audit, the Centers for Medicare & Medicaid Services (“CMS”) uncovered non-compliance by Aetna Health Inc. of Texas (“Aetna”) in calculating key payment information for air ambulance services under the No Surprises...more

Health Care Compliance Association (HCCA)

Overlapping surgeries: Time for a compliance checkup?

Overlapping surgeries is a practice that has been used for many years by healthcare providers (such as hospitals and surgical centers). This practice generally refers to situations where one lead attending surgeon is...more

NAVEX

Addressing Cybersecurity Expectations in Healthcare

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2024 is shaping up to be a very active year for regulatory and enforcement developments in the healthcare industry – developments that concern not just hospitals and nursing facilities, but many non-healthcare companies as...more

McNees Wallace & Nurick LLC

The OIG Releases Updated General Compliance Program Guidance

As 2023 came to a close, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) released an updated General Compliance Program Guidance (GCPG) manual, which serves as a reference guide for...more

Health Care Compliance Association (HCCA)

News Briefs: September 11, 2023

The HHS Office for Civil Rights (OCR) on Sept. 7 announced a proposed rule to bar discrimination based on disability.[1] “The rule, Nondiscrimination on the Basis of Disability in Programs or Activities Receiving Federal...more

McDermott Will & Emery

Private Investors and Digital Health Attracting OIG Attention: General Compliance Program Guidance to Watch

McDermott Will & Emery on

On November 6, 2023, the US Department of Health and Human Services (HHS) Office of Inspector General (OIG) published the General Compliance Program Guidance (GCPG) as a revised reference guide for the healthcare compliance...more

Bass, Berry & Sims PLC

HHS Releases Groundbreaking General Compliance Program Guidance, Setting New Standards for Healthcare Entities

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On November 6, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) released the most up-to-date, comprehensive, and practical general compliance guidance in decades. The new...more

Health Care Compliance Association (HCCA)

Defensibility of a fair market value analysis

Fair market value (FMV) is a pinnacle issue with respect to healthcare regulatory compliance and compensation agreements. This article will analyze the issues related to an FMV defensibility analysis of compensation...more

Health Care Compliance Association (HCCA)

FCA Lawsuit Alleges Three Hospitals Were Overpaid PRF ‘High-Impact’ Money and Kept It

Report on Medicare Compliance Volume 32, no 25 (July 2023) The former chief hospital executive of Bayonne Medical Center (BMC) in New Jersey has filed a False Claims Act (FCA) lawsuit alleging the hospital and two others...more

Health Care Compliance Association (HCCA)

News Briefs: July 2023

Report on Medicare Compliance Volume 32, no 25 (July 2023) Hospices in four states will face heightened oversight. “CMS is placing newly enrolling hospices located in Arizona, California, Nevada, and Texas in a provisional...more

King & Spalding

Federal District Court Grants Injunction Barring CMS from Implementing New Policy on Medicaid Funding Designed to Prevent...

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On June 30, 2023, the United States District Court for the Eastern District of Texas (the Court) granted the State of Texas’ preliminary injunction motion, enjoining CMS from implementing and enforcing its Informational...more

Foley & Lardner LLP

Key Takeaways from the Foley/PYA “Let’s Talk Compliance” 2-Day Virtual Conference

Foley & Lardner LLP on

Session #1: State of the Healthcare Industry Effective Compliance Plans and Enforcement Trends - In their discussion of compliance program effectiveness and enforcement, attorneys Kolarik and Waltz and Ms. Sumner...more

Ankura

Behind the Expert: Applying a Proactive Approach to Healthcare Compliance with Nancy Waltermire

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"Rather than reacting, you must be proactive and preventive. By doing this, you will not only be prepared for the potential obstacles that face your company, but you will most likely eliminate obstacles before they appear." ...more

Stoel Rives - Health Law Insider®

CMS Issues Final Rule Authorizing Extrapolation as Part of RADV Audits

As a result of a new rule published on February 1, 2023, at 88 Fed. Reg. 6643, Medicare Advantage (MA) organizations soon will be facing enhanced exposure from Risk Adjustment Data Validation (RADV) audits. Under the new...more

Ankura

Bringing Innovation to Healthcare Compliance and Disputes with Dorothy DeAngelis

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"Diverse Perspectives, Results Delivered comes to mind when I think about our team here at Ankura. It's how we operate every day. From the makeup of our team to the way we collaborate with clients, we are constantly striving...more

Fenwick & West LLP

Compensating Physician Advisors with Equity: Considerations for Life Sciences Companies

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Life sciences companies often engage physicians as consultants and advisors to serve on scientific or clinical advisory boards, or to otherwise obtain their expertise relating to product-specific research and development,...more

Jackson Lewis P.C.

Four Key Takeaways from the American Society for Health Care Human Resources Administration Annual Conference

Jackson Lewis P.C. on

The American Society for Health Care Human Resources Administration (ASHHRA) recently held an incredibly useful conference bringing together healthcare human resources leaders from around the country. Here are four key...more

Seyfarth Shaw LLP

Seyfarth Policy Matters Newsletter - April 2020 #3

Seyfarth Shaw LLP on

Congress Replenishes Paycheck Protection Program (PPP) Through its Phase Four Coronavirus Relief Package. On Tuesday, via unanimous consent, the Senate passed the Paycheck Protection Program Increase Act of 2020...more

Seyfarth Shaw LLP

Senate Passes Another Round of Coronavirus Relief to Replenish the Paycheck Protection Loan Program and Other Programs;...

Seyfarth Shaw LLP on

Summary - Late yesterday, the Senate passed the Paycheck Protection Program Increase Act of 2020. The measure appropriates a total of $484 billion, mainly to refund the Paycheck Protection Program (PPP), but also to provide...more

Foley & Lardner LLP

CARES Act: Non-Profit Employers’ Obligation for Unemployment Benefits Reimbursement

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Under the CARES Act (Coronavirus Aid, Relief, and Economic Security Act), the federal government will pay 50% of the reimbursable unemployment benefits from March 13, 2020 through December 31, 2020 for those non-profit...more

Chambliss, Bahner & Stophel, P.C.

CARES Financial Relief for Health Care Providers

The CARES Act adds $100 billion to the “Public Health and Social Services Emergency Fund” to reimburse “eligible health care providers” for “health care-related expenses or lost revenues that are attributable to Coronavirus.”...more

Chambliss, Bahner & Stophel, P.C.

CARES Relief for State and Local Governments

The CARES Act establishes a $500 billion loan program accessible by cities, states, and businesses, while also providing for more than $250 billion in direct funding to state and local governments. The majority of the direct...more

ArentFox Schiff

IRS Clarifies Interaction of Payroll Tax Deferral with PPP Loan Forgiveness Under CARES Act

ArentFox Schiff on

On April 10, the Internal Revenue Service published responses to frequently asked questions with respect to the payroll tax deferral provisions of the CARES Act, including clarification that employers that take loans under...more

Snell & Wilmer

CARES Act Appropriates $100 Billion for Healthcare Providers

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With the passage of the CARES Act, $100 billion has been appropriated to the Public Health and Social Services Emergency Fund (“PHSSEF”), to be administered by a small agency within the Department of Health and Human Services...more

Sheppard Mullin Richter & Hampton LLP

Answers for Nonprofits Seeking Relief under the CARES Act

In this time of crisis, nonprofits of all shapes and sizes have been scrambling to obtain assistance under the federal CARES Act. Sheppard Mullin’s Nonprofit Team is grateful for the special opportunity to help by partnering...more

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