News & Analysis as of

Physician Payments

Foley & Lardner LLP

Compliance Compass: The Erlanger Complaint – A Cautionary Reminder About the Importance of FMV

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Although most health care lawyers and compliance officers who review and analyze physician compensation understand that fair market value (FMV) is important, the nuances around FMV are sometimes missed....more

McDermott Will & Emery

[Webinar] PPMS in 2024: Spotlight on the MedSpa Sector - February 1st, 12:00 pm - 1:00 pm ET

McDermott Will & Emery on

The physician practice management (PPM) space continues to evolve in response to shifting market trends, demand for specialized care and emerging opportunities in underutilized sectors. While PPM deal volume and the creation...more

Weintraub Tobin

Themes from American Health Law Association’s 2023 Institute on Medicare and Medicaid Payment Issues

Weintraub Tobin on

I am fresh back from Baltimore, Maryland, where I was on the faculty of AHLA’s annual Institute on Medicare and Medicaid Payment Issues. I have been on the faculty of this program for a dozen years, and am always thrilled to...more

McDermott Will & Emery

2022 Health Policy Outlook

McDermott Will & Emery on

COVID-19 - The pandemic continues to loom large (maybe larger than ever) with surges driven by new variants, soaring hospitalizations and mounting deaths, and for as long as that continues, expect strong focus from the...more

Health Care Compliance Association (HCCA)

Kim Brandt on the Latest Washington Healthcare News

Kim Brandt, partner at Tarplin, Downs & Young has long provided the healthcare community with her expertise in all things Washington, having spent substantial time at CMS, the OIG at HHS and on Capitol Hill. She’ll be...more

Health Care Compliance Association (HCCA)

[Event] Chicago Regional Healthcare Compliance Conference - October 22nd, Chicago, IL

Our one-day Regional Compliance Conferences provide attendees with a forum to interact with local compliance professionals, share information about your compliance successes and challenges, and create educational...more

Goodwin

Patient Stakeholder Group Zeroes in on Medical Device Industry

Goodwin on

In recent months, the Kaiser Health Network (part of the Kaiser Family Foundation) has issued three reports scrutinizing the orthopedic industry and its practices. Each report articulates the stakeholder group’s concerns over...more

Sheppard Mullin Richter & Hampton LLP

On Your Mark, Get Set, Go: Life Science Companies Face A Challenging Year For Compliance With New Open Payment Program Data...

The Physician Payment Sunshine Act (the “Sunshine Act”) – a federal law first adopted as Section 6002 of the Patient Protection and Affordable Care Act of 2010 (“PPACA”) – requires the Centers for Medicare and Medicaid...more

Polsinelli

OIG Issues Guidance on Speaker Programs By Drug and Device Companies

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This week, the HHS Office of Inspector General (OIG) issued a Special Fraud Alert providing insight into speaker programs put on by drug and medical device companies that the OIG considers signs of potential fraud. Generally,...more

Health Care Compliance Association (HCCA)

Report on Medicare Compliance Volume 29, Number 32. News Briefs: September 2020

Report on Medicare Compliance Volume 29, no. 32 (September 14, 2020) -  In an audit of 100 outlier payments, the HHS Office of Inspector General (OIG) said Baylor Scott & White – College Station, a hospital in Texas, didn’t...more

Health Care Compliance Association (HCCA)

Report on Medicare Compliance Volume 29, Number 28. News Briefs: August 2020

Report on Medicare Compliance 29, no. 28 (August 3, 2020) - The HHS Office of Inspector General (OIG) has given the green light to a plan by a charitable organization to “purchase or receive donations of unpaid medical...more

Baker Donelson

OIG Approves Discount Medical Plan Arrangement with Chiropractors in Advisory Opinion 20-03

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In Advisory Opinion 20-03, published July 1, 2020, the Office of Inspector General (OIG) approved an arrangement in which a discount medical plan organization (DMPO) that receives annual membership fees from its members also...more

Polsinelli

2020 Medicare Physician Fee Schedule - Reimbursement and Payment Policy Proposals

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On July 29, 2019, the Centers for Medicare & Medicaid Services (CMS) released the FY 2020 Medicare Physician Fee Schedule (MPFS) proposed rule [CMS-1715-P] (Proposed Rule). A link to the full rule is available here....more

Robinson+Cole Health Law Diagnosis

DOJ Intervenes in FCA Suit Against Spinal Device Manufacturer and Senior Executives that Allegedly Paid Kickbacks to Surgeons

In a complaint filed on July 22, 2019, the U.S. Attorney’s Office for the Southern District of New York (DOJ) intervened in a qui tam False Claims Act (FCA) suit against Life Spine Inc. (Life Spine), and senior executives of...more

Baker Donelson

OIG's List of Excluded Individuals/Entities – What Employers Need to Know

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OIG maintains a list of all currently excluded individuals and entities called the "List of Excluded Individuals/Entities," or LEIE. Covered entities that hire – or continue to employ or work with – an individual or entity on...more

Baker Donelson

CMS Implements Enhanced Oversight of New Home Health Agencies

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CMS recently announced through an MLN Matters article that it intended to place new home health agencies (HHAs) under enhanced oversight for a provisional period. The authority for CMS's oversight flows from a provision in...more

Michigan Auto Law

No-Fault: How do doctors get paid by insurance companies?

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For years, doctors’ and hospitals’ medical bills have been slashed by No-Fault insurers using the insurers’ own de facto medical-provider fee schedules - How do doctors get paid by insurance companies under Michigan...more

Chartwell Law

When a Physician Demands Fees Above the Florida Statutory Fee Schedule

Chartwell Law on

On March 7, 2019, the Florida 1st District Court of Appeals addressed “what happens when a workers’ compensation claimant seeks care from a doctor who—as a condition of continued treatment—demands compensation above and...more

Robinson+Cole Health Law Diagnosis

In Amicus Brief, Government Discourages Supreme Court Review of Pro-Relator Ninth Circuit FCA Decision, but Pledges to Seek...

On November 30, 2018, the Solicitor General of the United States filed a long-awaited amicus brief in response to the U.S. Supreme Court’s request for the government’s view of the False Claims Act (FCA) case U.S. ex rel....more

Holland & Knight LLP

CMS Releases the 2019 MPFS and QPP Final Rules

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• The Centers for Medicare & Medicaid Services (CMS) has published the Calendar Year (CY) 2019 Final Rule for the Medicare Physician Fee Schedule (PFS), which includes provisions related to Medicare physician payments as well...more

Baker Donelson

Proposed Home Health Regulations Add a Number of Key Substantive Changes

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In its proposed HH PPS regulations published in the Federal Register on July 12, 2018, CMS would implement substantive changes for home health agencies. The proposed rule would rebase the market basket and update the payment...more

Foley & Lardner LLP

Direct Provider Contract Alternative Payment Model - CMS/CMMI Issues Request for Information

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On April 23, 2018, the Center for Medicare and Medicaid Innovation issued a Request for Information (the RFI) on a direct provider contracting model for primary care. The RFI seeks input on how direct provider contracting...more

Hogan Lovells

Understanding sunshine rules: how new transparency regulations in Europe are changing relationships between industry and health...

Hogan Lovells on

The 2010 Physician Payments Sunshine Act created a new standard of transparency for financial relationships between pharmaceutical companies and health care professionals in the U.S. Now, countries across Europe are following...more

Robinson+Cole Health Law Diagnosis

OIG Reports That CMS Paid Practitioners For Telehealth Services That Failed To Meet Medicare Requirements

On April 5, 2018, the Office of the Inspector General (OIG) announced its findings that the Centers for Medicare and Medicaid Services (CMS) paid practitioners for telehealth services that did not meet Medicare requirements....more

Foley & Lardner LLP

California Medicaid Agency Proposes Significant Restrictions on FQHC and RHC Reimbursement

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California’s Medicaid agency has posted draft language of a new state plan amendment (SPA) that would make major changes to federally qualified health center (FQHC) and Rural Health Clinic (RHC) reimbursement. Public comments...more

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