Amy O'Neill on Medicare

CMS Lifts COVID-19 Vaccine Requirements for Long Term Care Facilities

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

6/8/2023 / Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Department of Health and Human Services (HHS) , Final Rules , Interim Final Rules (IFR) , Long Term Care Facilities , Medicaid , Medicare , Public Health Emergency

HHS Publishes Ownership Data for Hospice and Home Health Agencies

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

4/26/2023 / Acquisitions , Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Enforcement , Home Health Agencies , Hospice , Medicare

OIG Audit Alleges that CMS Made $1.9 Million in Overpayments for Chronic Care Management Services During 2017 and 2018

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

8/18/2021 / Audits , Centers for Medicare & Medicaid Services (CMS) , Chronic Care Managment (CCM) , Medicare , OIG

CMS Issues New Rule Imposing Education About, and Access to, COVID-19 Vaccines and Reporting Requirements for Nursing Home and...

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

5/19/2021 / Centers for Disease Control and Prevention (CDC) , Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Interim Final Rules (IFR) , Medicaid , Medicare , Nursing Homes , Reporting Requirements , Vaccinations

Court of Appeals Upholds CMS Rule Requiring Public Disclosure of Prices Negotiated Between Hospitals and Insurance Companies

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

Victory for Hospitals as Judge Rules that CMS’s Reduction of Medicare Payments for Outpatient E&M Services Was Ultra Vires

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

Texas Court Dismisses False Claims Act Allegations Against Texas Hospital System

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

8/14/2019 / Dismissals , False Claims Act (FCA) , Federal Rules of Civil Procedure , Healthcare Fraud , Hospitals , Medicare , Qui Tam

OIG Highlights Top 25 Unimplemented Recommendations to Reduce Fraud, Waste, and Abuse in HHS Programs

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

8/1/2019 / ACOs , Annual Reports , Department of Health and Human Services (HHS) , Fraud Abuse and Waste , Information Reports , Medicare , Medicare Shared Savings Program , OIG , Skilled Nursing Facility

Provider Reimbursement Review Board Seeks Input on Board Rules

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

4/12/2019 / Centers for Medicare & Medicaid Services (CMS) , Comment Period , Health Care Providers , Hospitals , Medicare , Provider Reimbursement Review Board

American Hospital Association and Others File Second Lawsuit Contesting Medicare Rate Cut for 340B Discount Drugs

On September 5, 2018, the American Hospital Association, the Association of American Medical Colleges, America’s Essential Hospitals, Eastern Maine Healthcare Systems, Henry Ford Health System, and Fletcher Hospital, Inc....more

9/11/2018 / Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Hospitals , Medicare , Outpatient Prospective Payment System (OPPS) , Section 340B

CMS Announces Proposed Rule to Revise the Medicare Shared Savings Program

On August 9, 2018, CMS issued a proposed rule for restructuring the Medicare Shared Savings Program (Shared Savings Program) which would, among other things, change the participation options available under the program for...more

8/15/2018 / ACOs , Centers for Medicare & Medicaid Services (CMS) , Fee-for-Service , Medicare , Medicare Shared Savings Program

CMS Announces Proposed Calendar Year 2019 Physician Fee Schedule with Significant Focus on Streamlining Documentation Processes...

On July 12, 2018, CMS released the unpublished version of the Calendar Year (CY) 2019 Proposed Physician Fee Schedule (PFS). The CY 2019 Proposed PFS reflects a response by CMS to stakeholder feedback regarding the need to...more

7/17/2018 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicaid , Medicare , Physician Fee Schedule , Physicians

New California Bill Attempts to Set Standard Pricing for Healthcare Services and Procedures

Assembly Bill 3087 seeks to establish a nine-person commission tasked with imposing set prices for specific services and procedures provided by hospitals and other healthcare providers in California. Medi-Cal, Medicare, and...more

4/20/2018 / Health Care Providers , Medi-Cal , Medicare

Significant Health Policy Changes Contained in Bipartisan Budget Act of 2018

On February 9, 2018, after passing the House and Senate, the President signed into law the Bipartisan Budget Act of 2018 (BBA). The BBA amends the Budget Control Act of 2011 (BCA) to increase the spending caps on both defense...more

2/14/2018 / Ambulance Providers , Bipartisan Budget Act , Civil Monetary Penalty , Health Care Providers , Healthcare Costs , Healthcare Reform , Medicare , Outpatient Services , Stark Law , Telehealth

D.C. Circuit Upholds CMS’s Outlier Reconciliation Process Finding Notice and Comment Rulemaking Was Not Required

On December 26, 2017, the United States Court of Appeals for the District of Columbia Circuit overturned a summary judgment decision of the District Court and held that the provisions of the 2010 Medicare Claims Processing...more

1/4/2018 / Centers for Medicare & Medicaid Services (CMS) , MACs , Medicare , Summary Judgment

Self-Administered Versions of Orencia and Cimzia Were Included In Calculating Medicare Part B Payment Costs Which Significantly...

A report issued by the OIG on November 21, 2017 found that inclusion of the more costly self-administered versions of Orencia and Cimzia when calculating Medicare Part B costs caused Medicare and its beneficiaries to pay an...more

12/7/2017 / Medicare , Medicare Part B , OIG

Amy O'Neill

King & Spalding

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