News & Analysis as of

Dept. of Health and Human Services Medicare

The United States Department of Health and Human Services is a federal executive department established in 1953, as part of the Department of Health, Education and Welfare. The Agency became independent in 1980... more +
The United States Department of Health and Human Services is a federal executive department established in 1953, as part of the Department of Health, Education and Welfare. The Agency became independent in 1980 and was renamed The Department of Health and Human Services at that time. HHS is charged with protecting and improving the health of the American population, as well as providing essential services.    less -

Electronic Health Records Vendor Agrees to $155 Million Settlement to Resolve FCA Allegations, Required to Make Free Upgrades to...

by King & Spalding on

On May 31, 2017, the DOJ announced a $155 million settlement with eClinicalWorks (ECW), one of the nation’s largest electronic health records (EHR) vendors, to resolve a False Claims Act lawsuit brought by a whistleblower. ...more

"Meaningfully Useful" Risk Mitigation Strategies for Providers Following the eClinicalWorks Settlement

by Jones Day on

The Health Information Technology for Economic and Clinical Health Act ("HITECH Act") established financial incentives under Medicare and Medicaid for eligible health care providers that adopt, implement, and demonstrate use...more

First Look at OIG’s FY 2017 Fraud Recoveries/Enforcement Activities

by Reed Smith on

The HHS Office of Inspector General (OIG) expects its investigative recoveries during the first half of fiscal year (FY) 2017 to top $2.04 billion – which is down from $2.77 billion for the first half of FY 2016. During this...more

Congressional Hearings, Markups Focus on Chronic Care, Drug Pricing, HHS Budget, Other Health Programs

by Reed Smith on

House and Senate committees have held a number of hearings recently to focus on health policy topics, including the following: - A Senate Health, Education, Labor & Pensions Committee hearing on “The Cost of Prescription...more

Privacy Tip #92 – Finally, HHS is Removing SSNs From Medicare Cards

For those of you who know me, you know that I have been very frustrated with the federal and state governments for continuing to use Social Security numbers for eligibility, enrollment and participating in Medicare and...more

Manatt on Health Reform: Weekly Highlights - June 2017 #2

CMS seeks input on potential market stabilization rulemaking; Iowa proposes a single standardized Marketplace plan and reinsurance program; and Centene will expand its Marketplace offerings for 2018, including adding new...more

OIG Faults CMS for its Medicare and Medicaid Improper Payment Rates

by King & Spalding on

Under the Improper Payments Information Act of 2002, as amended, the Department of Health and Human Services (HHS) is required to annually report on improper payments and meet certain improvement metrics. In a report...more

OIG Publishes Semiannual Report to Congress

Earlier this month, the Office of the Inspector General for the Department of Health and Human Services (“OIG”) published its Semiannual Report to Congress covering the period from October 1, 2016 to March 31, 2017. The...more

Appeals Court Upholds Charity Care Patient Population Exclusion from DSH Payments

by King & Spalding on

On May 9, 2017, the U.S. Court of Appeals for the District of Columbia Circuit affirmed a lower court ruling denying hospitals from including New Jersey Charity Care Program (NJCCP) patients in the hospitals’ disproportionate...more

President Trump’s Proposed FY 2018 Budget Spares Medicare, But Calls for Deep Medicaid Cuts & FDA User Fee Hikes

by Reed Smith on

President Trump has released his FY 2018 budget proposal, which the Administration dubs “A New Foundation for American Greatness.” The proposed budget – which received a generally chilly reception on Capitol Hill – offers a...more

Trump Administration FY 2018 Budget and Healthcare Programs

by Holland & Knight LLP on

The Trump Administration released on May 23, 2017, its full Fiscal Year (FY) 2018 budget request, titled "A New Foundation for American Greatness." President Donald Trump's request builds off of the administration's March 16...more

FY 2018 President’s Budget May Signal Challenges for Health Programs on the Horizon

by McDermott Will & Emery on

Eric Zimmerman, along with McDermott+Consulting Vice Presidents Adaeze Enekwechi and Piper Su, wrote this +Insights publication detailing the possible effects of the Trump Administration's 2018 budget on health programs and...more

The OIG 2017 Work Plan Includes Focus on Hospitals - Corridors Newsletter April 2017

by Poyner Spruill LLP on

The U.S. Department of Health and Human Services (DHHS) Office of Inspector General (OIG) has issued its Work Plan for Fiscal Year 2017. The annual Work Plan provides a summary of new, revised, and continuing reviews for DHHS...more

Hospital Claim Dismissed for Want of Redressability

by Faegre Baker Daniels on

The recent decision in Dignity v. Burwell is interesting for three reasons. For one thing, it provides a reminder of the unfortunate fact that the acts (or inaction) of one party can adversely affect the fate of others—as...more

HHS Final Rule on Medicare Coverage Determination Appeals Process Takes Effect

by King & Spalding on

HHS’s final rule revising procedures for ALJ and Medicare Appeals Council level appeals, announced on January 17, 2017, took effect on March 20, 2017....more

Update: HHS Decides Appeals Backlog Rule

by Polsinelli on

On January 17, 2017, HHS published a rule addressing public comments and finalizing changes to the Medicare benefit claim appeals processes that were proposed on July 5, 2016. Although there was initially some speculation...more

HHS and Medicare Asked to Expand Coverage for Genetic Tests

by Foley & Lardner LLP on

Fifteen members of Congress have asked the Department of Health and Human Services (HHS) and the Medicare Payment Advisory Commission (Medicare) to examine how the federal government can help improve patient access to genetic...more

OIG Issues Favorable Advisory Opinion Relating to Free Hotel Lodging and Cafeteria Meals for Qualifying Patients

by Arnall Golden Gregory LLP on

On March 3, 2017, the U.S. Department of Health and Human Services, Office of Inspector General (OIG) issued Advisory Opinion 17-01. The Opinion relates to a request by an academic medical center (the “Requestor”) consisting...more

Excluded Party Cases Dominate OIG Published Self Disclosure Settlements

by Ruder Ware on

In 2013, the HHS Office of Inspector General issued revised protocols outlining the process through which health care providers are able to self-disclose and resolve potential liability under the OIG’s civil monetary penalty...more

HHS States that Agency Will Not Be Able to Meet Deadline to Clear Medicare Appeals Backlog

by King & Spalding on

In a status report filed on March 6, 2017, HHS revised projections regarding the Medicare appeals backlog, which make it unable to meet a court-imposed deadline to eliminate the backlog by 2020. The status report was filed in...more

HHS Secretary Backs Medicare Balance Billing

by Faegre Baker Daniels on

Generally speaking, patients really dislike balance billing. Sometimes called “surprise billing,” “balance billing” refers to billing a patient for the difference between the health care provider’s charge and the amount a...more

Regulatory “Freeze” Thaws for HHS: Medicare FY 2018 IPPS/LTCH Rulemaking Process Gets Underway

by Reed Smith on

The Centers for Medicare & Medicaid Services (CMS) is moving ahead on its annual Medicare hospital payment update rule – and it actually is ahead of last year’s pace. Specifically, on March 8, 2017 CMS sent to Office of...more

2017 Washington, D.C. Preview

by Baker Donelson on

With President Donald Trump in the White House and Republican majorities in both the House and Senate, 2017 will see Republicans looking to undo much of President Obama's legacy and advance longstanding policy priorities....more

Shorts On Long Term Care March 2017 - News for the NC LTC Community

by Poyner Spruill LLP on

Thursdays with Mama - Life has a rhythm, a symmetry, a meter, a metric. It’s rarely smooth or perfect. It’s knots and knuckles, bumps and bruises. It’s rough and tumble. It sings its own song in its own...more

What’s in Your Local Transportation Policy?

by Nossaman LLP on

Those in the business of providing healthcare services to Medicare and Medicaid beneficiaries are all too familiar with the federal Anti-kickback Statute (AKS). Among other dreadful sanctions, it imposes criminal penalties on...more

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