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Humana Bundles Up; Files Suit To Recover Hundreds Of Millions In Risk Corridor Payments From Uncle Sam

On November 2, Humana filed a lawsuit in the United States Court of Federal Claims to recover approximately $600 million allegedly owed by the United States government. See Humana Inc. v. U.S., case number 1:17-cv-01664. ...more

A Category 5 Compliance Problem: Hurricane Irma Gives Providers a Stark Reminder of Emergency Preparedness Realities

The havoc that Hurricane Irma caused in the Caribbean and most of Florida reminds us of the Centers for Medicare and Medicaid Services (CMS) requirements for emergency preparedness, which take effect November 15....more

CMS Requires Participating Providers to Prepare for Emergencies

On March 24, 2017, the Centers for Medicare & Medicaid Services (CMS) released a memorandum encouraging participating providers to “seek out and participate in a full-scale, community-based exercise with their local and/or...more

Mandatory Bundled Payments Delayed, CMS seeking comments

CMS Administrator, Seema Verma, and Secretary of Health and Human Services Secretary, Tom Price delayed implementation of the Comprehensive Care for Joint Replacement (“CJR”) program via an interim final rule. See CMS – 5519...more

New HHS Cybersecurity Preparedness Checklist

The Department of Health and Human Services’ Office of Civil Rights (OCR) recently published a checklist to guide HIPAA-covered entities and business associates through an appropriate response to a ransomware or cybersecurity...more

Fate of the American Health Care Act in the Hands of the Senate

On May 4, the U.S. House of Representatives passed the American Health Care Act (AHCA) by a slight majority (217-213). As we previously wrote, AHCA...more

Provider Beware: MACRA Implementation Fraught with Fraud and Abuse Implications

Although the fate of the Center for Medicare and Medicaid Innovation (CMMI) and the mandatory alternative payment models thereunder face threat of repeal under Republican leadership, the Medicare Access and Chip...more

Will “Trumpcare” Replace Obamacare by April?

Monday, House Republicans revealed two bills collectively meant to repeal and replace the Affordable Care Act (ACA). House committees began reviewing the legislation yesterday. The bills do not contain any major surprises and...more

The Affordable Care Act: On the Fast Track to Repeal

On January 20, hours after his inauguration, President Donald Trump issued an executive order directing the heads of all executive departments and agencies to “waive, defer, grant exemptions from, or delay the implementation...more

The New “Price” of U.S. Health Care: The Future of Value-based Reimbursement Under President-elect Trump and Tom Price

The total U.S. health care expenditure was $3.2 trillion in 2015, and is projected to grow to nearly $5.6 trillion by 2025. As our nation’s cost of care rises, both Democrats and Republicans recognize the overwhelming need to...more

The MACRA Final Rule: 10 Things You Need to Know

The Centers of Medicare and Medicaid Services (CMS) released the much-anticipated Medicare Access and CHIP Reauthorization Act (MACRA) final rule this month. The rule makes extensive changes to traditional Medicare Part B...more

MACRA: Top 10 FAQs

Significant changes to the Medicare payment system are underway. The Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) is set to take effect January 1, 2017. MACRA represents a deliberate departure by the...more

4 Key Requirements of CMS’ New Emergency Preparedness Rule

In an effort to establish consistent emergency preparedness requirements, increase patient safety, and ensure coordinated responses to catastrophes, the Centers for Medicare and Medicaid Services (CMS) released the Emergency...more

NOTICE Act Scheduled to Take Effect This Fall

The Final Rule of the Notice of Observation Treatment and Implications for Care Eligibility Act of 2015 (Pub. L. 114-42) is scheduled to become effective October 1, 2016. Thereafter, hospitals and Critical Access...more

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