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
The Office of Inspector General (OIG) has announced the launch of a new tool, which OIG has titled the “Fraud Risk Indicator.” A preliminary page for the Fraud Risk Indicator is available here on OIG’s website. OIG’s stated...more
On June 25, 2018, a three-judge panel on the U.S. Court of Appeals for the Sixth Circuit ruled in United States v. Paulus that the trial court judge wrongly overturned a Federal jury’s conviction of a Kentucky cardiologist...more
Attorney General Jeff Sessions announced last week that DOJ will not defend certain provisions of the Accordable Care Act in a challenge brought by the attorneys general of 20 states. The coalition of attorneys general filed...more
OIG recently issued Advisory Opinion No. 18-02 addressing free samples provided by a company that distributes and sells ostomy products. The OIG Advisory Opinion found that, although the company’s practice of distributing...more
On April 24, 2018, CMS issued the annual Hospital Inpatient Prospective Payment System (IPPS) and Long Term Acute Care Hospital (LTCH) Prospective Payment System (PPS) Proposed Rule for FY 2019 (the Proposed Rule) which will...more
A South Carolina jury found three individuals liable for violations of the Federal False Claims Act (FCA) in a qui tam whistleblower action in which DOJ intervened. The defendants, owners of a specialized laboratory company...more
The new Tax Cuts and Jobs Act has changed certain provisions of the Internal Revenue Code (the Code) pertaining to the deductibility of amounts paid to Government entities for violations of law. Section 162(a) of the Code has...more
On Wednesday, September 13, the House Ways and Means Committee gave unanimous approval to H.R. 3726, the Stark Administrative Simplification Act (the “Bill”). The Bill would amend the Stark law, codified at 42 U.S.C. §...more
District courts nationwide have been split on the issue of whether the two-part falsity test set forth in the U.S. Supreme Court’s opinion in Universal Health Services v. Escobar must always be satisfied in federal False...more
Last month, the Maine Legislature passed an amendment to the Maine Pharmacy Act to prohibit licensed manufacturers and wholesalers of pharmaceuticals from offering certain gifts to practitioners authorized to prescribe and...more
Last week OIG released its semiannual report to Congress, which details the results of OIG’s operations for the first half of the 2017 federal fiscal year. Healthcare fraud recoveries by OIG totaled $2.04 billion during the...more
Anthem announced on Friday, May 12, 2017 that it delivered formal notice to Cigna of termination of the parties’ merger agreement. The announcement comes on the heels of a Delaware Chancery judge’s denial, issued late...more
On Friday, February 24, 2017, Politico released details of a leaked draft House GOP “repeal and replace” bill (Draft) aimed at dismantling key provisions of the ACA, including Medicaid expansion, the individual mandate,...more
3/9/2017
/ Abortion ,
Affordable Care Act ,
Block Grants ,
Disproportionate Share Adjustments ,
Essential Health Benefits ,
Health Insurance ,
Health Savings Accounts ,
Healthcare Reform ,
Medicaid ,
Non-Grandfathered Health Plans ,
Repeal ,
Subsidies ,
Tax Credits
This month, the United States District Court for the District of Utah dismissed a relator’s allegations that a cardiac surgeon and two hospitals based in Utah violated the federal False Claims Act (FCA) by billing Medicare...more
The U.S. District Court for the District of Columbia issued an order on December 5, 2016 compelling HHS to meet certain annual targets to resolve its backlog of hundreds of thousands of pending Medicare claim appeals. HHS...more
On November 17, 2016, House Budget Committee Chairman Rep. Tom Price (R-GA) provided some insights on the major changes Republicans plan to make to the Affordable Care Act and Medicare in 2017. The remarks come on the heels...more
On October 14, 2016, CMS issued its Final Rule for the new physician payment system under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MACRA replaced the Medicare Sustainable Growth Rate (SGR) with a new...more
10/25/2016
/ Alternative Payment Models (APM) ,
Centers for Medicare & Medicaid Services (CMS) ,
EHR ,
Final Rules ,
Medicare ,
Medicare Access and CHIP Reauthorization (MACRA) ,
Medicare Part B ,
MIPS ,
Payment Systems ,
Physician Payments ,
Physicians ,
PQRS ,
Quality Payment Program (QPP) ,
Sustainable Growth Rate (SGR) ,
Value-Based Payments
On September 8, 2016, CMS issued its Final Rule establishing requirements for hospitals and other providers and suppliers to plan and prepare for natural and man-made disasters. CMS explained that it is adopting the new...more
On August 17, 2016 the United States District Court for the District of Columbia granted summary judgment in favor of HHS in a dispute over whether Part C days can be treated as “days entitled to benefits under Part A” for...more
8/25/2016
/ Arbitrary and Capricious ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Disproportionate Share Adjustments ,
Hospitals ,
Managed Care Contracts ,
Medicare ,
Medicare Part A ,
Medicare Part C ,
Notice and Comment ,
Summary Judgment
On July 11, 2016, the HHS Office for Civil Rights (OCR) released new HIPAA guidance regarding ransomware. The Fact Sheet, issued by OCR on July 11, covers various issues relating to ransomware, including reporting...more