On December 7, 2023, OCR released a statement that it was settling a phishing cyber-attack investigation into Lafourche Medical Group (the Medical Group) which specializes in emergency medicine, occupational medicine, and...more
Minnesota recently passed a state law providing the Minnesota Attorney General additional authority to determine whether mergers of health systems are in the public interest and enjoin or unwind deals found not to be in the...more
On May 31, 2023, CMS issued a final rule (Final Rule) repealing COVID-19 vaccination requirements for staff and testing requirements for staff and patients of long-term care (LTC) facilities. These were previously required...more
On May 15, 2023, a unanimous three-judge panel for the Fifth Circuit issued a per curiam order temporarily staying the Texas U.S. District Court decision by Judge O’Connor which held that the ACA preventative care mandate...more
On April 20, 2023, HHS announced that it is releasing ownership data for all Medicare-certified hospice and home health agencies not previously available to the public in this way. There are more than 6,000 hospices and...more
On June 21, 2022, the Supreme Court denied certiorari in the case of UnitedHealthcare Co., et al v. Becerra et al., Case No. 21-1140, wherein UnitedHealthcare attempted to overturn the D.C. Circuit Court’s revival of CMS’s...more
On April 18, 2022, the Supreme Court tossed two consolidated cases from Arkansas and New Hampshire addressing work requirements for Medicaid coverage that required potential Medicaid beneficiaries to work, attend school, or...more
Last week, CMS issued a final rule addressing several topics, including changes to the physician fee schedule (PFS) and changes to Medicare Part B payment policies. Key changes include a net reduction in the PFS conversion...more
11/16/2021
/ ACOs ,
Centers for Medicare & Medicaid Services (CMS) ,
Coronavirus/COVID-19 ,
Final Rules ,
Medicare Part B ,
Medicare Shared Savings Program ,
Payment Systems ,
Physician Fee Schedule ,
Public Health Emergency ,
Telehealth ,
Vaccinations
On October 20, 2021, HHS published in the Federal Register a proposal to repeal two final rules issued during the Trump administration. The final rules up for repeal are the “Department of Health and Human Services Good...more
10/26/2021
/ Affordable Care Act ,
Biden Administration ,
Department of Health and Human Services (HHS) ,
Enforcement Actions ,
Executive Orders ,
Federal Register ,
Final Rules ,
Jurisdiction ,
Medicaid ,
New Guidance ,
Public Health Insurance Marketplace
In a report issued by OIG in August of 2021, OIG alleged that for Chronic Care Management (CCM) services, “providers billed for and received overpayments totaling $1,918,278, and beneficiaries were required to pay a total of...more
Third party discovery may be helpful to providers in arbitrations. For example, if a provider is in a dispute with a health plan, if there are questions as to whether the health plan or the medical group has financial...more
On May 11, 2021, CMS issued an interim final rule requiring that nursing homes and other congregate care facilities: (1) educate all residents and staff about COVID-19 vaccines; (2) offer COVID-19 vaccines to all residents...more
On March 29, 2021, the Federal Communications Commission (FCC) unanimously approved the process for distributing $249.95 million in additional funding to healthcare providers to help cover the costs of telecommunication...more
On January 28, 2021, HHS issued a fifth amendment to the Declaration under the Public Readiness and Emergency Preparedness Act (PREP Act), expanding the categories of persons able to prescribe, dispense, and administer...more
On December 29, 2020, the U.S. Court of Appeals for the District of Columbia Circuit upheld a CMS final rule promulgated in November 2019 that requires hospitals to disclose various forms of pricing information related to the...more
1/7/2021
/ Affordable Care Act ,
American Hospital Association ,
Appeals ,
Centers for Medicare & Medicaid Services (CMS) ,
Hospitals ,
Insurance Industry ,
Medicare ,
PHSA ,
Price Transparency ,
Pricing ,
Public Disclosure ,
Reimbursements ,
Secretary of HHS
On February 24, 2020, the Ninth Circuit, sitting en banc, upheld the Trump administration’s regulation that prohibits grantees under Title X of the Public Health Service Act from referring patients for, or otherwise...more
OIG recently updated its interactive map that displays details on nursing home complaint trends to incorporate data from 2016 through 2018. OIG had previously conducted a study and published an interactive map showing...more
On September 17, 2019, U.S. District Judge Rosemary M. Collyer of the U.S. District Court for the District of Columbia awarded summary judgment in favor a group of more than 40 hospitals on their challenge to CMS’s decision...more
9/28/2019
/ Administrative Procedure Act ,
American Hospital Association ,
Centers for Medicare & Medicaid Services (CMS) ,
Congressional Intent ,
Exhaustion Doctrine ,
Health Care Providers ,
Hospitals ,
Judicial Review ,
Lack of Authority ,
Medicare ,
Medicare Payment Reform ,
Off-Campus Departments ,
Outpatient Prospective Payment System (OPPS) ,
Provider Payments ,
Summary Judgment ,
Ultra Vires
On August 4, 2019, U.S. District Judge David A. Ezra dismissed with prejudice a $61.8 million False Claims Act (FCA) case brought by relator Integra Med Analytics LLC (Plaintiff) against Baylor Scott & White Health, Baylor...more
OIG recently released its annual publication of Solutions to Reduce Fraud, Waste, and Abuse in HHS Programs: OIG’s Top Recommendations (July 2019 Edition). In the July 2019 Edition, OIG focused on the top 25 unimplemented...more
On June 13, 2019, Eighth Circuit Judge Steven M. Colloton wrote on behalf of a three-judge panel confirming a December 2017 injunction that prohibits Sanford Health and its subsidiary Sanford Bismarck from acquiring Mid...more
On May 13, 2019, in a unanimous decision, the United States Supreme Court held that even in cases where the government does not intervene in a False Claims Act (FCA) action, a relator is entitled to rely on the portion of the...more
5/22/2019
/ Appeals ,
Cause of Action Accrual ,
Cochise Consultancy Inc v United States ex rel Hunt ,
Dismissals ,
False Claims Act (FCA) ,
Federal Contractors ,
Intervenors ,
Limitation Periods ,
Qui Tam ,
Reaffirmation ,
Relators ,
Reversal ,
SCOTUS ,
Statute of Limitations
On March 18, 2019, the Provider Reimbursement Review Board (PRRB) announced that it is inviting comments, suggestions, and other feedback in connection with five topic areas: (1) continued implementation and improvement of...more
On January 24, 2019, OIG issued Advisory Opinion No. 19-02, analyzing a proposed arrangement in which a pharmaceutical manufacturer would loan smartphones to patients who meet certain poverty level requirements in order to...more
2/5/2019
/ Advisory Opinions ,
Anti-Kickback Statute ,
Beneficiary Inducement ,
Civil Monetary Penalty ,
Digital Health ,
Health Care Providers ,
Low-Income Issues ,
Manufacturers ,
Medical Devices ,
New Guidance ,
OIG ,
Patient Assistance Programs ,
Patient Safety ,
Pharmaceutical Industry ,
Smartphones
On November 20, 2018, Defendants-Petitioners in Brookdale Senior Living Communities, Inc. v. U.S. ex rel. Prather (Brookdale), filed a petition for writ of certiorari with the U.S. Supreme Court (the High Court) asking the...more