Medicare

News & Analysis as of

CMS Withdraws Proposed Medicare Secondary Payer Rule

On October 8, 2014, the Centers for Medicare & Medicaid Services (“CMS”) withdrew its Notice of Proposed Rule Making (“NPRM”) from the Office of Management and Budget that was to address how Medicare’s future interests should...more

Eighth Circuit Says That Considerations Of Health Care Cost Savings Could Be Proxy For Age In ADEA Suits

The Eighth Circuit recently concluded that an employer may violate the ADEA by terminating an older employee in order to reduce its health care premiums. Tramp v. Associated Underwriters, Inc., 2014 WL 4977396 (8th Cir....more

Health Care Reform Implementation Update

In the past week, CMS has released several advisories including updates to the rating system for nursing homes, premium and deductible information for Medicare Part B and Part D for 2015, Pioneer ACO results, payment dispute...more

OIG Proposed Anti-Kickback Safe Harbors and CMP Regulations: The End of Frustration or Just the Beginning?

On October 3, 2014, the U.S. Department of Health and Human Services Office of Inspector General (OIG) published an unexpected, yet long-awaited, set of proposed rules that would add new anti-kickback law safe harbors,...more

Critical Access Hospital Soothsayers and the 96-Hour Physician Certification Requirement

This year critical access hospitals (CAH) have struggled to implement procedures to comply with both the "two-midnight" rule and the 96-hour physician certification requirement. The combination of both puts physicians in a...more

Fifth Circuit Holds Multiple Disclosures Establish Loss Causation in Securities Action

The US Court of Appeals for the Fifth Circuit recently held that multiple partial “corrective” disclosures collectively may satisfy the requirements of pleading loss causation in a securities fraud class action, even if no...more

FICA Payroll Taxes Must Be Withheld From Employees Switching From F-1 To H-1B Status*

As a reminder, employers need to be mindful when foreign national employees change from a nonimmigrant status exempt from Social Security and Medicare withholding under the Federal Insurance Contributions Act (FICA) to a...more

Seniors Needn’t Drive into the City to Get Overcharged!

Remember when you had to drive into the city to get overcharged? Those days are over. According to a report issued Wednesday by the Office of Inspector General of Health & Human Services, Medicare patients pay two to six...more

CMS Issues 2013 RAC Report to Congress

On September 29, 2014, CMS released the Fiscal Year (FY) 2013 Recovery Audit Contractor (RAC) report. According to the report, RACs collected $3.65 billion in Medicare overpayments during FY 2013. In addition, the report...more

Does the Medicare Telehealth Parity Act of 2014 Stand a Chance?

“Telehealth saves money and helps save lives. By expanding telehealth services, we can make sure the best care and the best treatments are available to all Americans, no matter where they live.” With those words, Rep....more

OIG Releases New Proposals on Anti-kickback Statute Safe Harbors, Exceptions to the CMP Law and the Gainsharing Prohibition

On October 3, 2014, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) published a long-awaited proposed rule for implementing amendments to safe harbors under the Anti-kickback Statute and...more

Hospice Industry Will Face Stricter Scrutiny Under New Law Aimed at Post-Acute Care Data Standardization

President Obama signed the “Improving Medicare Post-Acute Care Transformation Act of 2014” or the IMPACT Act of 2014 (the Act) on October 6, 2014. The new law is broadly focused on requiring all post-acute care providers to...more

Special Needs Trusts: Writing a Letter of Intent

A special needs trust is vital if you are the parent or caretaker of a child (or adult child) with mental or physical disabilities. A trust can make certain that your child is cared for properly, that they have enough...more

CMS to Modernize Home Health Regulations - Proposed rule targets quality of care, more flexible procedures

On October 9, 2014, the Centers for Medicare and Medicaid Services (CMS) issued a Proposed Rule revising current conditions of participation (CoPs) that home health agencies (HHAs) must meet in order to participate in the...more

OIG Releases Proposed Rule Adding New Safe Harbors to the Anti-Kickback Statute

Last week, the HHS OIG released a proposed rule published in the October 3 Federal Register that would add new safe harbors to the Anti-Kickback Statute and expand the list of conduct exempt from civil monetary penalties...more

Analysis and Impact of the Improving Medicare Post-Acute Care Transformation Act of 2014

This week, President Obama signed into law the Improving Medicare Post-Acute Care Transformation Act of 2014 (the “IMPACT Act” or “Act”). The IMPACT Act’s provisions will affect a broad range of post-acute care (“PAC”)...more

CMS Offers To Settle All Acute Care Inpatient Claim RAC Appeals

CMS is offering to pay hospitals 68 percent of the allowable amount for all claims that are currently on appeal. Specifically, CMS is offering to settle "inpatient status" claims at 68 percent of the "net paid amount" within...more

FDA Regulatory and Compliance Monthly Recap - September 2014

In This Issue: - FDA sends warning letters to companies that made claims on social media that their products treat, cure Ebola, marking the first time the agency singles out Pinterest - OIG issues special...more

Today’s Riddle: When Does Medicare Fine Hospitals for Admitting Sick Seniors?

Give up? It’s when the sick senior was treated at that same hospital less than 30 days ago for heart attack, heart failure, or pneumonia. Starting in less than three months, the list of conditions will be expanded to cover...more

Whistleblower Goes It Alone to Secure $5 Million Settlement under False Claims Act

The potential success of a whistleblower lawsuit filed under the False Claims Act (FCA) is significantly reduced when the government fails to intervene because such cases are often assumed to lack merit. However, a plaintiff...more

OIG Offers Greater Protections for Health Care Providers in New Proposed Rule

On October 3, 2014, the U.S. Department of Health and Human Services of the Office of Inspector General (OIG) issued a Proposed Rule amending both the safe harbors to the anti-kickback statute and the civil monetary penalty...more

Sometimes the Government is Here to Help: OIG Proposes More Flexibility in Rules Governing Local Transportation, Beneficiary...

The U.S. Department of Health & Human Services, Office of Inspector General ("OIG") just released a proposed rule (“Proposed Rule”) that provides long awaited guidance on patient transportation services, relaxes the...more

OIG Warns Pharmaceutical Manufacturers of Improper Part D Beneficiary Coupon Use

On September 19, 2014, the U.S. Department of Health and Human Services Office of Inspector General (“OIG”) released a study showing that pharmaceutical manufacturer safeguards to prevent Medicare Part D (“Part D”)...more

Medicare Enrollment: A Primer and How to Avoid Traps for the Unwary

Health-care professionals, facilities and equipment suppliers must be enrolled in the Medicare program to receive payment for covered items and services. In 2006, the Centers for Medicare & Medicaid Services adopted a...more

Medicaid ACOs: States’ Answer to Escalating Costs?

States increasingly are experimenting with the use of Accountable Care Organizations (ACOs) in their Medicaid programs as a possible avenue to curb the escalating costs of providing care to expanding Medicaid populations....more

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