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Increased Enforcement Activity Expected Relating to Healthcare Provider Billing Upcoding

A pair of recent reports issued by the Health and Human Services Office of Inspector General (“OIG”) and Cotiviti, a Centers for Medicare and Medicaid Services (“CMS”) Recovery Audit Contractor (“RAC”), indicate a resumed...more

The Return of Subregulatory Guidance Reliance

Subregulatory guidance plays an important role in providing direction and insight into complex regulatory rules. Heavily regulated industries, such as the healthcare industry, are well-versed in subregulatory guidance. It may...more

CMS Finalizes Major Stark Law Rule

The Centers for Medicare & Medicaid Services (“CMS”) delivered welcome news in advance of the Thanksgiving holiday by issuing its final rule (the “Final Rule”) on November 20, 2020 to amend current regulations interpreting...more

Murky Waters – The Stark Controversy in Hospital-Physician Relationships

Since the completion of this article, CMS has announced that its final Stark law rule will be published in the Federal Register on December 2, 2020. I. Introduction - The Stark Law has been litigated for the past two...more

CMS Addresses Common Questions Regarding Stark Waivers for COVID-19 Purposes

The COVID-19 pandemic has created the need for flexibility in physician arrangements during the public health emergency. In response to that need, the Centers for Medicare and Medicaid Services (“CMS”) issued Stark waivers,...more

CMS Announces Reevaluation and Suspension of the Accelerated and Advance Payment Programs

The Centers for Medicare & Medicaid Services (“CMS”) surprised stakeholders on Sunday, April 26, with an announcement that it would be reevaluating the amounts that will be paid under its Accelerated Payment Program and...more

OIG Issues AKS Policy Statement Following Stark Waivers

The Office of Inspector General (“OIG”) recently issued guidance to reduce administrative burdens facing health care providers during the COVID-19 pandemic related to the Anti-Kickback Statute (“AKS”). The AKS is a criminal...more

CMS Issues Stark Waivers for COVID-19 Purposes

CMS issued new Stark waivers on Monday evening, March 30, giving providers unprecedented flexibility to manage arrangements through the COVID-19 pandemic. While regulatory requirements are still in effect and these waivers...more

CMS Publishes Final Rule Announcing New Enrollment and Participation Enforcement Authorities

The Centers for Medicare & Medicaid Services (“CMS”) recently issued a final rule with comment period (CMS-6058-FC) implementing statutory provisions that afford CMS new denial and revocation authorities related to Medicare...more

Proposed Coordinated Care Revisions to the Medicare Physician Self-Referral Law

The Centers for Medicare & Medicaid Services (“CMS”) issued a proposed rule (“Proposed Rule”) on October 9, 2019 to amend current regulations interpreting the Medicare physician self-referral law (the “Stark” law).  ...more

CMS Continues to Eye Reforms to Stark Law, Requests Public Input

The Centers for Medicare and Medicaid Services (CMS) issued a Request for Information (RFI) on June 20, 2018 seeking input from the public on how to address “any undue regulatory impact and burden” of the physician...more

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