Isabella Wood on Medicare

Twenty-One State Attorneys General and the District of Columbia Back HHS’s Plan to Hold Hospitals and Other Providers Liable for...

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

OIG Principal Deputy Inspector General Speaks at AHLA Fraud and Compliance Forum

On September 22, 2021, OIG Principal Deputy Inspector General Christi Grimm delivered a keynote speech to the American Health Law Association (AHLA) Fraud and Compliance Forum. Consistent with her remarks this spring at the...more

10/11/2021 / AHLA , Compliance , Coronavirus/COVID-19 , Enforcement , Fraud , List of Excluded Individuals/Entities (LEIE) , Medicaid , Medicare , Nursing Homes , OIG , Request For Information

OIG Issues Favorable Advisory Opinions Regarding Medigap Plan and Preferred Hospital Organization Arrangements

Last week, OIG posted Advisory Opinions Nos. 21-03, 21-04, and 21-05 relating to three near-identical arrangements between Medigap plans and Preferred Hospital Organizations (PHOs). The arrangements involve (i) a discount on...more

6/1/2021 / Anti-Kickback Statute , Beneficiary Inducement , Civil Monetary Penalty , Deductibles , Medicare , Medicare Part A , Medigap , OIG , Preferred Hospital Networks Arrangement , Safe Harbors

CMS Delays Implementation of Radiation Oncology Payment Model for Six Months in Response to Industry Feedback

On October 21, 2020, CMS announced that it is pushing the implementation of its radiation oncology payment model (RO Model) back from January 1, 2021 to July 1, 2021 in response to industry concerns regarding the...more

11/5/2020 / Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Final Rules , Medicare

OIG Issues Advisory Opinion on Discount Medical Plan Organization Arrangement

On July 1, 2020, OIG published an advisory opinion regarding a discount medical plan organization (DMPO). A DMPO is not an insurer but contracts with providers who agree to reduce their fees for the DMPO’s members. Under...more

7/9/2020 / Advisory Opinions , Anti-Kickback Statute , Chiropractors , Medicare , OIG , Remuneration

CMS Releases, Then Withdraws, Additional Guidance Regarding Application of Two-Midnight Rule to Total Knee Arthroplasties

On January 8, 2019, almost exactly a year after CMS removed total knee arthroplasties from the Medicare Inpatient-Only List, CMS released additional guidance regarding the application of the Two-Midnight Rule to these cases. ...more

1/16/2019 / Centers for Medicare & Medicaid Services (CMS) , Medicare , Outpatient Prospective Payment System (OPPS) , Two-Midnight Rule

CMS Releases Final Rule for Medicare Physician Fee Schedule and Quality Payment Program

On November 1, 2018, CMS issued a final rule (“Final Rule”) which finalizes numerous changes to the Medicare Physician Fee Schedule (“PFS”), the Quality Reporting Program, and the Medicare Shared Savings Program (“MSSP”). ...more

11/8/2018 / Centers for Medicare & Medicaid Services (CMS) , Medicare , Medicare Shared Savings Program , Physician Fee Schedule , Physicians

CMS Proposes Revising Medicare Conditions of Participation

On September 20, 2018, CMS published a proposed rule that the agency states is aimed at reducing the regulatory burden for providers by revising certain aspects of the Medicare Conditions of Participation and Conditions of...more

9/26/2018 / Ambulatory Surgery Centers , Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Hospice , Hospitals , Medicare

Federal District Court Rules Hospital System May Sue Medicare Advantage Plan for Underpayments

On June 22, 2018, the United States District Court for the Central District of California denied Humana’s motion to dismiss a suit brought by a large nationwide hospital system, Prime Healthcare Services (Prime). In a...more

7/5/2018 / Hospitals , Medicare , Medicare Advantage , Medicare Advantage Organizations (MAOs)

Medicare Restarting Home Health Pre-Claim Review Demonstration Project

On May 31, 2018, CMS published a notice indicating its intention to re-launch a previously abandoned home health demonstration project, but with some modifications. CMS proposes that the new demonstration project would...more

6/8/2018 / Centers for Medicare & Medicaid Services (CMS) , Home Health Agencies , Medicare

CMS Proposes Changes to Inpatient Admission Orders in 2019 IPPS Proposed Rule

On April 24, 2018, the Centers for Medicare & Medicaid Services (CMS) released the Fiscal Year (FY) 2019 Inpatient Prospective Payment System (IPPS) Proposed Rule (CMS-1694-P). Among other changes, CMS proposes eliminating...more

5/1/2018 / Centers for Medicare & Medicaid Services (CMS) , Inpatient Prospective Payment System (IPPS) , Medicaid , Medicare , Medicare Part A , Two-Midnight Rule

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

Class Certification Granted in Suit Regarding Medicare Outpatient Status

On July 31, 2017, the United States District Court for the District of Connecticut certified a nationwide class of Medicare beneficiaries in an action against HHS regarding whether patients can appeal their status as an...more

8/11/2017 / Class Certification , Department of Health and Human Services (HHS) , Medicare , Outpatient Services

CMS Announces Progress in Shift Toward Alternative Payment Models

This week, CMS announced several important developments relating to provider participation in alternative payment models (APMs). On October 25, 2016, CMS released a fact sheet summarizing key developments relating to APMs...more

11/2/2016 / ACOs , Alternative Payment Models (APM) , Centers for Medicare & Medicaid Services (CMS) , Medicare

Lawmakers Join MedPAC in Speaking Out Against CMS Surgeon Data Collection Proposal

On September 16, 2016, approximately 112 congressional representatives submitted a letter to HHS Secretary Sylvia Matthews Burwell and CMS acting Administrator Andy Slavitt requesting that CMS not implement its proposal...more

10/3/2016 / Centers for Medicare & Medicaid Services (CMS) , Children's Health Insurance Program (CHIP) , Data Collection , Department of Health and Human Services (HHS) , Medicare , MedPAC , Physician Fee Schedule , Physicians

Isabella Wood

King & Spalding

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