On November 2, 2021, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2022 Medicare Physician Fee Schedule (PFS) final rule (Final Rule), which finalized several noteworthy policies related...more
The U.S. Department of Health and Human Services Office of Inspector General (OIG) recently issued two data briefs addressing challenges with the provision of behavioral health services to Medicaid enrollees, and calling for...more
Although the 21st Century Cures Act: Interoperability, Information Blocking, and the ONC Health IT Certification Program Final Rule ("Final Rule") was published on May 1, 2020, there are prohibitions and exceptions regarding...more
The Department of Health and Human Services has released extensive and significant revised final rules governing the Physician Self-Referral Law (the Stark law) and the Medicare Anti-Kickback Statute (AKS) in furtherance of...more
12/21/2020
/ Anti-Kickback Statute ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Health Care Providers ,
Patients ,
Payment Systems ,
Physicians ,
Safe Harbors ,
Self-Referral ,
Stark Law ,
Value-Based Care
On August 3, 2020, CMS issued proposed rules announcing and soliciting public comments on new policy changes for Medicare payments under the Calendar Year (CY) 2021 Physician Fee Schedule (PFS) and other Medicare Part B...more
In its Advisory Opinion (AO), AO 20-04, HHS Office of the Inspector General (OIG) determined that the requestor, a charitable organization that locates, buys and forgives patient medical debt, may purchase or receive as...more
On June 25, 2020, Centers for Medicare and Medicaid Services (CMS) issued a proposed rule to make permanent all the flexibilities concerning the use of technology and telecommunications systems introduced for home health...more
CMS recently issued its second round of changes to the Medicare regulations in response to the COVID-19 Public Health Emergency (PHE). CMS published its first interim final rule with comment period addressing the PHE in the...more
The Coronavirus Preparedness and Response Supplemental Appropriations Act, which was enacted on March 6, 2020, allows the Secretary of the United States Department of Health and Human Services (HHS) to waive certain...more
3/21/2020
/ Centers for Medicare & Medicaid Services (CMS) ,
Coronavirus/COVID-19 ,
Department of Health and Human Services (HHS) ,
Emergency Response ,
Health Care Providers ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Medicare ,
OCR ,
Physicians ,
Relief Measures ,
Telehealth ,
Telemedicine ,
Waivers
The Centers for Medicare & Medicaid Services (CMS) recently updated its advisory opinion regulations, codified at 42 CFR §§ 411.370 through 411.389, in a final rule issued November 15, 2019. The update liberalizes and...more
12/23/2019
/ ACOs ,
Advisory Opinions ,
Amended Rules ,
Centers for Medicare & Medicaid Services (CMS) ,
Certifications ,
Department of Health and Human Services (HHS) ,
False Claims Act (FCA) ,
Final Rules ,
Health Care Providers ,
Physicians ,
Public Comment ,
Rescission ,
Self-Referral ,
Stark Law
In furtherance of its goals of expanding the adoption of electronic health records (EHR) and improving security through the use of cybersecurity technology, the Department of Health and Human Services (HHS) has proposed...more
11/13/2019
/ 21st Century Cures Act ,
Anti-Kickback Statute ,
Centers for Medicare & Medicaid Services (CMS) ,
Cost-Sharing ,
Cybersecurity ,
Department of Health and Human Services (HHS) ,
Donations ,
EHR ,
Electronic Protected Health Information (ePHI) ,
Exceptions ,
OIG ,
Popular ,
Safe Harbors ,
Software ,
Stark Law
The proposed rules released by the Department of Health and Human Services Office of Inspector General (OIG) and the Centers for Medicare & Medicaid Services (CMS) on Wednesday, October 9, 2019 include new exceptions and safe...more
In Advisory Opinion 19-04, published September 10, 2019, the Office of Inspector General (OIG) approved an online health care directory operated on a per-click or per-booking fee arrangement. The proposed directory will be...more
9/24/2019
/ Advisory Opinions ,
Anti-Kickback Statute ,
Beneficiary Inducement ,
Fees ,
Fraud and Abuse ,
Health Care Providers ,
Marketing ,
OIG ,
Pay-Per-Click ,
Physicians ,
Price Transparency ,
Provider Payments ,
Safe Harbors ,
Websites
When the Centers for Medicare and Medicaid Services (CMS) sought input on ways to address the undue burdens of the Stark law through a Request for Information (RFI) in June 2018, its anticipated focus was care coordination,...more
The Director of the Civil Fraud Section of the Department of Justice (DOJ), Michael Granston, issued a memo in January 2018 noting the recent increase in qui tam lawsuits filed under the False Claims Act (FCA). The Granston...more
1/31/2019
/ Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Health Care Providers ,
Motion to Dismiss ,
Prosecutorial Discretion ,
Public Interest ,
Qui Tam ,
Relators ,
Resource Management ,
Split of Authority ,
The Granston Memo
Advanced Medical Technology Association (AdvaMed) has released the first update to its Code of Ethics on Interactions with U.S. Health Care Professionals (the Code) since July 2009. The new Code, announced January 9, 2019,...more