Last week, the Supreme Court issued its opinion in Advocate Christ Medical Center v. Kennedy, siding with the government and holding that, for purposes of the Medicare disproportionate share hospital (DSH) calculation,...more
5/9/2025
/ Becerra Secretary Of Health And Human Services v Empire Health Foundation For Valley Hospital Medical Center ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Government Agencies ,
Healthcare ,
Healthcare Facilities ,
Hospitals ,
Medicaid ,
Medicare ,
Payment Systems ,
SCOTUS ,
Statutory Interpretation ,
Supplemental Security Income (SSI)
On Friday, April 11, 2025, CMS issued its annual Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) Proposed Rule for Fiscal Year (FY) 2026 (the Proposed...more
4/22/2025
/ Centers for Medicare & Medicaid Services (CMS) ,
Healthcare ,
Healthcare Facilities ,
Hospitals ,
Inpatient Prospective Payment System (IPPS) ,
Long-Term Care ,
Medicare ,
Payment Systems ,
Proposed Rules ,
Prospective Payment System (PPS) ,
Regulatory Agenda ,
Regulatory Requirements ,
Rulemaking Process
Last week, OIG’s Office of Audit Services released its latest report on Medicare Administrative Contractors’ (MACs) compliance with Medicare cost report oversight requirements. The report, which is titled Medicare...more
3/31/2025
/ Audits ,
Centers for Medicare & Medicaid Services (CMS) ,
Government Agencies ,
Healthcare ,
Healthcare Fraud ,
Hospitals ,
Medicare ,
Medicare Administrative Contractors (MAC) ,
OIG ,
Regulatory Oversight ,
Reimbursements
Last week, HHS Office of Civil Rights (OCR) announced a settlement with a Pennsylvania provider (the Provider) concerning an alleged violation of the HIPAA Privacy Rule. Specifically, the Provider impermissibly disclosed a...more
12/18/2024
/ Compliance ,
Corrective Action Plans (CAPs) ,
Department of Health and Human Services (HHS) ,
Final Rules ,
Health Insurance Portability and Accountability Act (HIPAA) ,
HIPAA Privacy Rule ,
Medical Records ,
OCR ,
PHI ,
Reproductive Healthcare Issues ,
Settlement
Earlier this month, OIG’s Office of Audit Services released its latest report on providers’ compliance with the Hospital Price Transparency Rule (the HPT Rule). The HPT Rule requires hospitals to make public (1) a...more
Last week, HHS published its final rule outlining disincentives for certain healthcare providers that have committed information blocking (the Final Rule). The Final Rule also provides information related to OIG’s...more
7/5/2024
/ 21st Century Cures Act ,
Department of Health and Human Services (HHS) ,
Electronic Medical Records ,
Enforcement Actions ,
Final Rules ,
Health Care Providers ,
Health Information Technologies ,
Information Blocking Rules ,
Information Technology ,
Investigations ,
OIG
On April 10, 2024, CMS issued its annual Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) Proposed Rule for Fiscal Year (FY) 2025 (the Proposed Rule). In...more
4/17/2024
/ Centers for Medicare & Medicaid Services (CMS) ,
Consolidated Appropriations Act (CAA) ,
Food and Drug Administration (FDA) ,
Graduate Medical Education ,
Inpatient Prospective Payment System (IPPS) ,
Long Term Care Facilities ,
Manufacturers ,
Medicare ,
Payment Systems ,
Proposed Rules ,
Prospective Payment System (PPS) ,
Provider Reimbursement Review Board ,
Supply Chain ,
Supply Shortages
Last week, CMS updated its technical implementation guide to the machine-readable file, a requirement of the Hospital Price Transparency Rule. The updated technical implementation guide—which contains data dictionaries, CSV...more
Earlier this month, OIG issued Advisory Opinion 23-07, a favorable opinion regarding an employer’s proposal to pay bonuses to its employed physicians based on net profits derived from certain procedures performed by the...more
Last week, the D.C. Circuit held that Medicare beneficiaries “entitled to supplemental security income [(SSI)] benefits under Title XVI of the Social Security Act” means only those patients receiving cash payments for...more
Last month, CMS issued three civil monetary penalty (CMP) notices for violations of the hospital price transparency regulations (HPT Rule), which requires hospitals to make public the standard charges of the items and...more
Last week, HHS announced the distribution of more than $560 million in Provider Relief Fund (PRF) Phase 4 General Distribution payments. These payments bring the Phase 4 distribution total to approximately $11.5 billion of...more
The Provider Relief Fund (PRF) Reporting Portal opened for Reporting Period 2 on January 1, 2022. Recipients who received one or more General and/or Targeted PRF payments exceeding $10,000 in the aggregate from July 1, 2020...more
Last week, HHS announced the distribution of approximately $9 billion in CARES Act Provider Relief Fund (PRF) Phase 4 payments. The average payment for small providers is $58,000, for medium providers is $289,000, and for...more
Last week, HHS released seven new and modified Frequently Asked Questions (FAQs) regarding payments distributed to providers via the CARES Act Provider Relief Fund. The FAQs cover a wide range of topics, including appealing...more
On September 30, 2021, the Biden Administration issued the second set of implementing regulations under the No Surprises Act. The interim final rules, issued by the Departments of Health and Human Services, Labor, and...more
On June 11, 2021, HHS published an updated Post-Payment Notice of Reporting Requirements (the Notice). Notably, the Notice describes how the period of availability of CARES Act Provider Relief Fund (PRF) payments is based on...more
On April 27, 2021, CMS issued the fiscal year (FY) 2022 proposed rule for the hospital inpatient prospective payment system (IPPS) and long-term care hospital (LTCH) prospective payment system (the Proposed Rule). Among...more
5/10/2021
/ ACOs ,
American Rescue Plan Act of 2021 ,
Bad Debt ,
CARES Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Children's Health Insurance Program (CHIP) ,
Consolidated Appropriations Act (CAA) ,
Coronavirus/COVID-19 ,
Graduate Medical Education ,
Hospitals ,
Inpatient Prospective Payment System (IPPS) ,
Interim Final Rules (IFR) ,
Long-Term Care ,
Medicaid ,
Medicare ,
Medicare Advantage ,
Medicare Part A ,
Medicare Shared Savings Program ,
Proposed Rules ,
Public Health Emergency ,
Rural Health Care Providers
On April 22, 2021, thirteen Medicaid beneficiaries, represented by the National Health Law Program, the Tennessee Justice Center, and King & Spalding, filed a complaint in the U.S. District Court for the District of Columbia...more
Last week, HHS released eleven modified Frequently Asked Questions (FAQs) regarding payments distributed to providers via the CARES Act Provider Relief Fund. The FAQs cover audits and overpayments, sharing funds with...more
On March 17, 2021, HHS notified Arkansas and New Hampshire officials that it was withdrawing its approval of demonstration projects which had permitted those states to impose work requirements as a condition for eligibility...more
Last week, as reported in the December 21 Health Headlines, bipartisan congressional leaders announced they had reached an agreement on a COVID-19 relief package––which would be combined into one end of year legislative...more
This month, HHS released over twenty new and modified Frequently Asked Questions (FAQs) regarding payments distributed to providers via the CARES Act Provider Relief Fund. The FAQs cover a wide range of topics, including...more
12/28/2020
/ CARES Act ,
Children's Health Insurance Program (CHIP) ,
Commercial Insurance Policies ,
Coronavirus/COVID-19 ,
Department of Health and Human Services (HHS) ,
Food and Drug Administration (FDA) ,
Medicaid ,
Medicare ,
Paycheck Protection Program (PPP) ,
Payment Systems ,
Provider Relief Fund ,
Reimbursements ,
SBA
Last week, CMS announced additional flexibilities that expand its Hospital Without Walls initiative, which provides broad regulatory flexibility that allows hospitals to provide services in locations beyond their existing...more
On October 22, 2020, HHS expanded the Provider Relief Fund Phase 3 General Distribution eligibility pool to include residential treatment facilities, chiropractors, and eye and vision providers that had not yet received any...more