On August 28, 2024, the U.S. Cybersecurity & Infrastructure Security Agency (CISA), together with the FBI and Department of Defense Cyber Crime Center, issued an advisory to U.S. organizations, including healthcare...more
On June 5, 2024, a federal court in the Western District of North Carolina declined to issue a preliminary injunction blocking the sale of two hospitals in Charlotte, North Carolina, finding that the proposed sale is not...more
On September 11, 2023, the HHS Office of Civil Rights (OCR) announced a settlement with LA Care Health Plan (LA Care) regarding LA Care’s potential HIPAA Security Rule violations. HHS and LA Care have executed a Resolution...more
On August 1, 2023, CMS issued its annual Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) Final Rule for FY 2024 (the Final Rule). In the Final Rule, CMS,...more
8/9/2023
/ Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Coronavirus/COVID-19 ,
Department of Health and Human Services (HHS) ,
DSH ,
Final Rules ,
Food and Drug Administration (FDA) ,
Inpatient Prospective Payment System (IPPS) ,
Long-Term Care ,
Medicaid ,
Medicare ,
Rural Health Care Providers ,
Social Security Act ,
Stark Law ,
Waivers
On June 8, 2023, the U.S. Supreme Court held that private individuals may sue publicly owned nursing homes for violations of the Federal Nursing Home Reform Act of 1987 (FNHRA). Plaintiff Gorgi Talevski and his wife brought...more
On December 13, 2022, CMS is set to publish in the Federal Register a proposed rule (Proposed Rule) requiring certain Medicare, Medicaid, Children’s Health Insurance Program, and Qualified Health Plan fee-for-service and...more
12/21/2022
/ Centers for Medicare & Medicaid Services (CMS) ,
Children's Health Insurance Program (CHIP) ,
Fee-for-Service ,
Healthcare ,
Managed Care Contracts ,
Medicaid ,
Medicare ,
Medicare Advantage ,
Payment Systems ,
Proposed Rules ,
Qualified Health Plans
On October 3, 2022, the Attorneys General for California, New York, and Massachusetts, in collaboration with Attorneys General from 18 other states and the District of Columbia (State Attorneys General) submitted a comment...more
10/14/2022
/ Affordable Care Act ,
Algorithms ,
Anti-Discrimination Policies ,
Decision-Making Process ,
Department of Health and Human Services (HHS) ,
Healthcare ,
Medicaid ,
Medicare ,
Proposed Rules ,
Request For Information ,
Risk Mitigation ,
State Attorneys General
On June 17, 2022, the First Appellate District of the California Court of Appeal issued a decision in Saini v. Sutter Health, Case No. A162081, affirming the decision of the Superior Court in Alameda County to dismiss class...more
On March 22, 2022, the U.S. Court of Appeals for the Ninth Circuit reversed the judgment of a district court that had ordered United Behavioral Health (UBH) to reprocess over 50,000 mental health and substance use disorder...more
On December 28, 2021, CMS announced that it would resume enforcement of its COVID-19 vaccine mandate for healthcare providers in areas not covered by injunctions issued by federal courts. As of December 15, 2021, federal...more
1/5/2022
/ Centers for Medicare & Medicaid Services (CMS) ,
Coronavirus/COVID-19 ,
Employer Mandates ,
Enforcement ,
Health Care Providers ,
Healthcare Workers ,
Injunctions ,
OSHA ,
Popular ,
Vaccinations ,
Virus Testing
Last week, HHS launched the application for both Provider Relief Fund (PRF) Phase 4 and American Rescue Plan (ARP) Rural payments. As described in the September 13, 2021 Health Headlines, HHS made $25.5 billion in new funding...more
On March 10, 2021, CMS revised its guidance on visitations to nursing homes in acknowledgement of the fact that millions of residents and staff in nursing facilities have received COVID-19 vaccinations in the last few months....more
On December 8, 2020, a federal court in Pennsylvania rejected a challenge by the Federal Trade Commission (FTC) and the State of Pennsylvania to block a $599 million merger of two hospital and healthcare systems in...more
On October 6, 2020, CMS announced new enforcement measures to ensure hospitals report daily COVID-19 data, with the exception of psychiatric and rehabilitation hospitals that must report weekly, to the federal government...more
10/15/2020
/ Centers for Medicare & Medicaid Services (CMS) ,
Coronavirus/COVID-19 ,
Hospitals ,
Influenza ,
Interim Final Rules (IFR) ,
Medicaid ,
Medicare ,
New Guidance ,
Public Health Emergency ,
Reporting Requirements ,
Termination
On September 17, 2020, HHS announced details about its $2 billion Provider Relief Fund (PRF) performance-based incentive payment distribution program for nursing homes and skilled nursing facilities originally announced on...more
OIG has updated its FAQs regarding the application of its administrative enforcement authorities to arrangements directly connected with COVID-19 with the addition of two new FAQs. On August 4, 2020, the OIG issued an FAQ...more
8/26/2020
/ Anti-Kickback Statute ,
Beneficiary Inducement ,
Clinical Laboratories ,
Coronavirus/COVID-19 ,
Department of Health and Human Services (HHS) ,
Emergency Use Authorization (EUA) ,
Federal Health Care Programs (FHCP) ,
Food and Drug Administration (FDA) ,
OIG ,
Public Health ,
Public Health Emergency ,
Virus Testing
On June 12, 2020, the IRS released proposed regulations on the enforcement of Section 4960 of the 2017 Tax Cuts and Jobs Act. Section 4960 imposes a 21% excise tax on “applicable tax-exempt organizations” (ATEOs), including...more
On March 17, 2020, OIG issued a policy statement titled, “Policy Statement Regarding Physicians and Other Practitioners That Reduce or Waive Amounts Owed by Federal Healthcare Program Beneficiaries for Telehealth Services...more
On February 7, 2020, two House committees released competing proposed bills designed to shield patients from “surprise” medical bills. These bills, like others that were proposed last year, would protect patients from...more
Health plans and their delegated IPAs are using a number of different tactics to deny payment for inpatient services by improperly classifying inpatient claims as observation or other types of outpatient status. Payers are...more
8/19/2019
/ Centers for Medicare & Medicaid Services (CMS) ,
Class Action ,
Constitutional Challenges ,
Department of Health and Human Services (HHS) ,
Health Insurance ,
Hospitals ,
Inpatient Billing ,
Managed Care Contracts ,
Medi-Cal ,
Medicare ,
Medicare Part A ,
Medicare Part B ,
Two-Midnight Rule ,
Underpayment
In 2016, CMS issued a proposed rule to update the requirements that hospitals and critical access hospitals must meet to participate in Medicare and Medicaid programs....more
On June 6, 2019, CMS issued a Request for Information (RFI) seeking new ideas from the public on how to decrease the administrative burden for healthcare providers, specifically the burden of “unnecessary paperwork.” The RFI...more
On Monday, March 25, 2019, the Department of Justice (DOJ) endorsed the decision of a district court judge in the Northern District of Texas that invalidated the entire Affordable Care Act (ACA) as unconstitutional. Texas v....more
4/5/2019
/ Affordable Care Act ,
Constitutional Challenges ,
Criminal Prosecution ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Fraud ,
Healthcare Fraud ,
Intervenors ,
Medicaid ,
Medicare ,
Nursing Homes ,
Preexisting Conditions
Senate Finance Committee Chairman Chuck Grassley (R-IA) renewed his focus on charitable hospitals by asking the IRS on February 19, 2019, for data on hospital compliance with § 501(r) of the Internal Revenue Code. Section...more
On January 8, 2019, the U.S. Supreme Court issued a unanimous opinion in Henry Schein, Inc. v. Archer & White Sales, Inc.—the first opinion authored by Justice Brett Kavanaugh—reaffirming that, where parties have agreed to...more
1/17/2019
/ Appeals ,
Arbitration ,
Arbitration Agreements ,
Arbitrators ,
Contract Terms ,
Exceptions ,
Federal Arbitration Act ,
Henry Schein Inc v Archer and White Sales Inc ,
Judicial Review ,
Motion to Compel ,
Question of Arbitrability ,
Remand ,
SCOTUS ,
Vacated ,
Wholly Groundless Doctrine