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CMS Relaunches Hospice TPE Audits with Long-Stay General Inpatient Reviews

The Centers for Medicare and Medicaid Services (CMS) announced that it had restarted the Targeted Probe and Educate (TPE) audit process, effective September 1, 2021. More recently, the Medicare Administrative Contractors for...more

HHS Makes More Provider Relief Funds Available, Offers 60-Day Grace Period for First Reporting Deadline

The US Department of Health and Human Services (HHS) recently announced that it will make $25.5 billion available in new COVID-19 relief funds to providers through the Health Resources and Services Administration (HRSA). To...more

How Does Climate Change Affect the Healthcare Industry?

The US Department of Health and Human Services recently announced the establishment of the Office of Climate Change and Health Equity (OCCHE). Noting that the OCCHE is “the first office of its kind at the national level to...more

CMS About to Relaunch Its TPE Audits After a Long COVID-19 Public Health Emergency Pause

A notable headline from the August 12 MLN Connects Newsletter for healthcare providers states “CMS Resumes Targeted Probe & Educate Program.” Designed to help providers reduce claim denials and appeals, CMS suspended...more

July Fast Break Recap: Fourth Circuit AKS Case Enforcement Analysis

We hope you were able to join us for our July Fast Break on the US Court of Appeals for the Fourth Circuit's recently affirmed $114 million judgment in United States v. Mallory. If not, you missed a great session, featuring...more

President Biden Expands Access to Affordable Care Act Exchange Plans, Women’s Reproductive Health

January 28 was designated as “health day” for President Joe Biden’s early push of executive orders, with two new executive actions added to a growing list. The Executive Order on Strengthening Medicaid and the Affordable Care...more

Equity-Focused Executive Orders Telling for Businesses Interacting with US Government

President Joe Biden’s first days in office have focused heavily on issues of diversity, inclusion, equity, and human rights as applied across federal agencies and programs. We anticipate that this pattern will continue and...more

HHS Delays Provider Relief Fund Reporting Deadline

The US Department of Health and Human Services (HHS) announced on Friday, January 15, 2021, one month before the former reporting deadline, that it will push back the CARES Act Provider Relief Fund (PRF) reporting timeline...more

Hospice: Consolidated Appropriations Act Revamps Medicare Survey and Certification Process

Modifications also include public disclosure of accreditation organization survey information and intermediate civil penalty remedies for noncompliance. The Consolidated Appropriations Act, 2021 (Pub. L. 116-260), signed into...more

Recent Anti-Kickback Safe Harbor Revisions: What Hospices Should Know

The US Department of Health and Human Services Office of Inspector General (OIG) recently issued important updates to its Anti-Kickback Statute (AKS) safe harbor rules that provide additional legal protections and...more

OIG Embraces Broader Anti-Kickback Statute Safe Harbor Protection for Warranties

The US Department of Health and Human Services’ Office of Inspector General updated the warranty safe harbor to account for bundled product and service warranties to reflect realities of healthcare product sales, but rejects...more

COVID-19: HHS Expands Phase 3 Relief Fund Provider Pool, Responds to ‘Lost Revenue’ Concerns

The US Department of Health and Human Services (HHS) issued two welcome announcements on October 22 relating to the CARES Act Relief Fund Provider Relief Fund (PRF). First, the agency expanded the pool of eligible recipients...more

Respite Care Flexibility During the COVID-19 Pandemic – A Pragmatic Legislative Fix

Imagine you are the primary caretaker for your 94-year-old terminally ill mother who lives in your home while under hospice care during the coronavirus (COVID-19) pandemic. ...more

CMS to Restart Medicare Audits Beginning August 3

The Centers for Medicare and Medicaid Services (CMS) recently announced that it intends to resume both prepayment and postpayment medical reviews conducted by the Medicare Administrative Contractors, Supplemental Medical...more

Staying Within the Legal Lane: Providing Products and Services for COVID-19

Companies marketing products or services for coronavirus (COVID-19) should be aware of key areas of healthcare law and regulation, including Food and Drug Administration regulation, clinical laboratory testing oversight,...more

DC Circuit Court: CMS Rule on Drug Pricing Disclosure Exceeds Statutory Authority

In an informative decision for challenging rules that portend government overreach, the US Court of Appeals for the District of Columbia Circuit upholds the invalidation of the Centers for Medicare and Medicare Services’ drug...more

Mid-May Provider Relief Fund FAQ Updates Offer Clarification and Consternation

With just days left until provider attestations are due related to acceptance of CARES Act Provider Relief Funds, the US Department of Health and Human Services (HHS) recently updated its FAQs providing some additional...more

CMS Expands Hospice Flexibilities to Fight COVID-19

CMS posted an expanded set, dated April 29, of Medicare regulatory flexibility measures for hospice organizations related to the coronavirus (COVID-19) pandemic, supplementing the previous COVID hospice flexibilities guidance...more

Paycheck Protection Program and Healthcare Enhancement Act Infuses Additional Funding Into COVID-19 Healthcare Efforts

US President Donald Trump signed the Paycheck Protection Program and Healthcare Enhancement Act (HR 266) into law on April 24. HR 266 appropriates $483 billion in new spending, including $321 billion for the Payment...more

CARES Act Relief Funds Offer Aid to Healthcare Providers, but Certifications and Overly Creative Use of Funds Are a Fraud Risk

Medicare (and in the future Medicaid) providers that receive grant money under the CARES Act Relief Fund must pay close attention to the terms and conditions of the assistance and rigorously document how the funds are used to...more

GAO Report Studies Disposal of Controlled Substances in Home Hospice Settings Following 2018 Law Change

Hospice officials identified both best practices and challenges that hospice employees face when disposing of controlled substances in a patient’s home. The US Government Accountability Office (GAO) released a report on April...more

DOJ and OIG Warn Against Fraud Schemes Related to COVID-19 Pandemic

In managing the quickly evolving healthcare landscape during this current crisis, healthcare companies should be wary of fraudsters who attempt to divert critical resources. ...more

COVID-19: Healthcare Enforcement & Program Integrity – Compassion or Business as Usual?

The coronavirus (COVID-19) has created the most dire public health and economic crisis in generations, and the US government is under intense pressure to provide the necessary relief to US citizens, healthcare providers, and...more

Retail Pharmacies Are Rising to the COVID-19 Challenge

Aided by ingenuity and growing regulatory flexibility, retail pharmacies across the country are finding ways to serve their customers while reducing face-to-face contact. Protocols may vary by state. ...more

CMS Issues Guidance on COVID-19 for Hospice and Nursing Home Providers

The Centers for Medicare & Medicaid Services (CMS) issued a statement on March 9 related to actions the agency is taking to protect the health and safety of patients and providers. CMS urges providers to stay abreast of CDC...more

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