News & Analysis as of

Health Care Update

In This Issue: Implementation of the Affordable Care Act; Other Congressional and State Initiatives; Other Health Care News; and Upcoming Hearings and Markups. Excerpt from Implementation of the Affordable Care...more

OIG Releases Fiscal Year 2014 Work Plan

On January 31, 2014, the Department of Health and Human Services Office of Inspector General (OIG) released its work plan for fiscal year 2014. The work plan identifies the programs OIG will review in the upcoming year. The...more

Health Reform + Related Health Policy News - January 2014, Issue 1

In This Issue: - Top News ..Congress Approves Budget Deal with Short-Term ‘Doc Fix' ..CMS “Two-Midnight” Rule delayed until March 31, 2014 ..Individuals with Canceled Insurance Policies May Apply for...more

2013 Healthcare Year In Review

Bob Dylan's quote from 1964 -- "The Times They Are A-Changin" -- could equally apply to the healthcare industry in 2013. This was the year that the Affordable Care Act ("ACA") came into full public view with the start of the...more

Dodging the AKS: Marketplace Plans Are Not "Federal Health Care Programs"

In an October 30th letter addressed to Congressman Jim McDermott, the Department of Health and Human Services (HHS) Secretary, Kathleen Sebelius, left little to interpretation: Qualified health plans (QHPs) purchased through...more

Health Reform + Related Health Policy News - October 2013 - Issue 3

In This Issue: - Top News ..Deal to Raise Debt Ceiling, End Shutdown Yields No Major Changes to Health Care Law ..Problems with HealthCare.gov Website Continue; HHS Working to Fix Issues ..Kaiser Study...more

Health Care E-Note - September 19, 2013

In This Issue: - Many States Want More Oversight of Health Insurance Navigators - Insurers, Hospitals Argue Over Who Pays When Enrollees Default - ACA Increases Scrutiny of Doctors' Gifts, Payments - States...more

OIG Issues Favorable Opinion Regarding Post-Discharge Services Arrangement

The Department of Health & Human Services Office of Inspector General (OIG) recently issued a favorable advisory opinion regarding an electronic health record vendor’s plan to provide services to hospitals to help manage...more

Health Reform + Related Health Policy News - July 2013

In This Issue: - Top News ..Obama Administration Delays Employer Mandate One Year ..House Energy and Commerce Committee Releases Draft Legislation for SGR Fix ..CMS Proposes Payment Changes for Medicare...more

"Health Care Enforcement Update: What Is in Store for the Next Five Years"

While predicting enforcement trends over the next five years is not without uncertainty, the best marker for future activity may be to look to the past. We believe that industry members and counsel can expect the Department...more

Health Care E-Note - June 19,2013

In This Issue: - FTC Hospital Merger Investigation Highlights Cost of Health Care - Survey Finds Doctors Warming to Health Information Exchanges - Health Insurance Markets Seeing More Competition from New...more

Examining Charitable Patient Assistance Programs -- Careful Due Diligence Yields Responsible Investment Decisions

In today’s challenging health care environment, nearly 30 million Americans suffering from various chronic and life-threatening illnesses are underinsured and have difficulty paying their out-of-pocket medical costs....more

Health Reform + Related Health Policy News - May 2013

In This Issue: - Top News ..Tavenner Wins Senate Confirmation to Head CMS ..US Charges 89 in Nationwide Medicare Fraud Crackdown - State News ..Vermont Becomes Fourth State to Allow Physician-Assisted...more

OIG Revises Special Advisory Bulletin on Exclusions

OIG continues its aggressive interpretation of scope and effect of exclusion from participation in Federal health care programs and clarifies several open questions....more

Health Care Reform Update -- April 15, 2013

In This Issue: Leading the News; Implementation of the Affordable Care Act (ACA); Other HHS and Federal Regulatory Initiatives; Other Congressional and State Initiatives; Other Health Care News; and Hearings and...more

Illinois Office of the Inspector General Self-Disclosure Protocol for Reporting Medicaid Overpayment

The Illinois Department of Healthcare and Family Services ("Department"), Office of Inspector General ("OIG"), has now issued an Informational Notice and Voluntary Provider Self-Disclosure Protocol ("Protocol") providing...more

HEALTH REFORM: OIG Issues Updated Guidelines for Evaluating State False Claims Acts: Is More State Litigation on the Horizon?

On March 15, 2013, the U.S. Department of Health and Human Services’ Office of Inspector General (“OIG”) released the Updated OIG Guidelines for Evaluating State False Claims Acts (“2013 Guidelines”), which replaces the...more

OIG Recommends Increased CMS Enforcement of SNF Standards

Amid alleged failures of skilled nursing facilities to meet care and discharge planning requirements, OIG identifies substantial payment errors....more

OIG Issues Updated Guidelines on State False Claims Laws

On March 15, HHS OIG issued updated guidelines regarding how it will evaluate State false claims acts. Under the Deficit Reduction Act of 2005, States became eligible for financial incentives (i.e., retaining a larger share...more

10 Fraud and Abuse Enforcement Trends You Can't Afford to Ignore in 2013

To paraphrase a famous quote, "Those who do not learn from history are doomed to repeat it," and providers who ignore the significance of the federal government's healthcare fraud enforcements efforts in 2012 do so at their...more

Deadline Looming (March 23, 2013) for Nursing Facilities to Have "In Operation" an "Effective Compliance and Ethics Program"

On March 23, 2013, it will have been three years since President Obama signed the Patient Protection and Affordable Care Act (ACA) into law. This date is a significant one for the nursing home industry, not because it marks...more

Birmingham Medical News: Make A New Year's Resolution To Review And Update Your Corporate Compliance Plan

Originally published in Birmingham Medical News, on January 7, 2013. Around this time each year, I like to remind my clients about matters they can address at the beginning of each year--a New Year's Resolution for the...more

Health Care Reform Update -- December 3, 2012

In This Issue: Implementation of the Affordable Care Act; Other HHS and Federal Regulatory Initiatives; Other Congressional and State Initiatives; Other Health Care News; and Hearings and Mark-Ups Scheduled. Excerpt...more

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