Incentives Centers for Medicare & Medicaid Services

News & Analysis as of

Limited Modifications in Final ACO Fraud and Abuse Waivers Most Notably Include Cut of Gainsharing CMP Waiver

Nearly four years after publishing their joint interim final rule with comment period, effective November 2, 2011 (IFC), the OIG and CMS (Agencies) have finalized the waivers of various fraud and abuse laws in the context of...more

Also In The News - Health Headlines - October 2015 #3

CMS Announces Part D Enhanced Medication Therapy Management Model Demonstration – On September 28, 2015, CMS announced a Part D Enhanced Medication Therapy Management Model (Enhanced MTM Model) that is designed to assess...more

OIG Recommends Improvements to SNF Billing for Changes in Therapy

In FYs 2011 and 2012, CMS adopted new patient assessments for skilled nursing facilities (SNFs) that were intended to capture when beneficiaries start therapy, end therapy, and decrease or increase therapy. The HHS Office of...more

Medicaid Managed Care Update: Accelerating State-Led Payment and Delivery System Reform

In the wake of the implementation of the Affordable Care Act, the recent Medicare Managed Care Proposed Rule (the Proposed Rule) exemplifies the accelerated push by the Department of Health and Human Services and Centers for...more

Healthcare Legal News Volume 5 Number 2

According to a recent study by Accenture, by 2017 approximately 18 percent of the American public will purchase insurance through exchanges versus relying on traditional employer healthcare coverage or foregoing insurance...more

Locke Lord QuickStudy: Recent Health Care Updates

On January 29, the Centers for Medicare & Medicaid Services (CMS) announced its plan to propose changes to the Electronic Health Record Incentive Program (EHR Incentive Program). According to CMS, the rule will address...more

CMS Issues Rewards and Incentive Guidance to MA Plans

On December 4, 2014, CMS issued additional guidance regarding rewards and incentives programs (“RI Programs”). This guidance elaborates on whether an RI Program can target members with specific diseases, whether rewards can...more

Final Meaningful Use Rule: CMS Loosens its Grip

The Centers for Medicare & Medicaid Services (“CMS”) finalized a rule on August 29th which should give providers some breathing room in complying with meaningful use requirements for the Electronic Health Record (“EHR”)...more

Maryland Health Care Commission Proposes to Extend and Revise EHR Incentive Regulations

On March 21, 2014, the Maryland Health Care Commission (MHCC) published proposed revisions to the existing Maryland Electronic Health Record Incentives regulations at COMAR 10.25.16. The proposed regulations [PDF] would...more

"Meaningful" Errors Require Hospital System To Refund $31M

In what is reported to be the largest repayment to date involving "meaningful use" incentive payments, Naples, Florida-based Health Management Associates, Inc. ("HMA"), with 71 inpatient facilities in 15 states, including...more

CMS Proposes Increased Rewards for Reporting Fraud and Abuse

The Centers for Medicare and Medicaid Services (CMS) recently published a proposed rule modifying certain provisions in their Incentive Reward Program (IRP) to sweeten the incentives for reporting sanctionable conduct....more

CMS Proposes Additional Incentives to Reduce Medicare Fraud Including Increase to Reward for Reporting Fraud

On April 24, 2013, CMS issued a proposed rule that would further incentivize Medicare beneficiaries and other individuals to report suspected Medicare fraud under the Medicare Incentive Reward Program. CMS is proposing to...more

CMS Requests Comments on Redundant Reporting of Clinical Quality Measures

CMS is seeking input regarding ways in which eligible professionals might use clinical quality measures (CQM) data reported to medical boards, specialty societies, regional health care quality organizations or other...more

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