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
On October 8, 2018, the Texas Department of Insurance fined Humana $700,000 and issued Consent Orders against Humana for failing to include an adequate number of anesthesiologists in three of the state’s largest metropolitan...more
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
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
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
On April 23, 2018, CMS released CMS-1727-R (the Ruling), which announced that it will follow the United States District Court’s decision in Banner Heart Hospital v. Burwell, 201 F. Supp. 3d 131 (D.D.C. 2016). The Banner...more
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
Last month, OIG released its Medicaid Fraud Control Units (MFCUs) report for Fiscal Year (FY) 2017. MFCUs investigate and prosecute Medicaid provider fraud and patient abuse and neglect and are jointly funded by the federal...more
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
On December 29, 2017, OIG issued a favorable advisory opinion interpreting the application of the gainsharing civil monetary penalty provision (Gainsharing CMP) and the Anti-Kickback Statute in connection with a proposed...more
On December 4, 2017, the DOJ announced a $7.5 million settlement with Pine Creek Medical Center, a Dallas-based physician-owned hospital. The settlement resolves allegations that the hospital paid physicians kickbacks in the...more
On October 13, 2017, a Jacksonville cardiovascular practice entered into an approximately $440,000 settlement to resolve allegations concerning violations of 42 U.S.C. 1320a-7k (the 60-Day Overpayment Rule) and its Florida...more
On September 6, 2017, CMS’s Center for Clinical Standards and Quality/Survey & Certification Group announced revisions to Appendix A of the State Operations Manual (SOM), which governs hospital surveys. The revisions are...more
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
On May 15, 2017, the U.S. Supreme Court overturned a Kentucky Supreme Court decision and sided with a nursing home operator regarding an attorney-in-fact’s ability to bind principals to arbitration clauses. The U.S. Supreme...more
On April 18, 2017, the United States District Court for the Middle District of Florida adopted the magistrate judge’s report and recommendation and granted BayCare Health System’s (BayCare’s) motion for summary judgment. The...more
On March 27, 2017, in conjunction with the Health Care Compliance Association (“HCCA”) annual Compliance Institute (“CI”), the Department of Health and Human Services (“HHS”), Office of the Inspector General (“OIG”) released...more
In a February 28, 2017 letter to the Department of Justice (DOJ), the American Medical Association (AMA) expressed concern regarding Anthem’s recent statements about a potential settlement with DOJ that would allow the...more
On February 15, 2017, CMS issued a proposed rule which the Trump administration contends will reform and stabilize the individual and small group health insurance market exchanges created pursuant to the Affordable Care Act...more
On November 22, 2016, CMS published its annual list of quality and efficiency measures under consideration for adoption through the rulemaking process. CMS is considering approximately 100 measures for incorporation into...more
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
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
On July 6, 2016, CMS released the Calendar Year (CY) 2017 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Proposed Rule. In addition to significant proposals...more