On December 12, 2018, Aurora Health Care (Aurora), a Wisconsin-based healthcare system, entered into a settlement agreement with the United States and the State of Wisconsin to pay $12 million to resolve allegations that...more
The Office of Inspector General (OIG) for the U.S. Department of Health & Human Services (HHS) recently released its annual publication identifying the top management and performance challenges facing HHS. In the 2018...more
On July 3, 2018, the U.S. District Court for the Northern District of Illinois issued a ruling dismissing Advocate Christ Medical Center (ACMC) from a False Claims Act suit brought by a former resident against ACMC and a...more
On May 14, 2018, the U.S. Attorney’s Office for the Southern District of Texas announced that Memorial Hermann Health System (MHHS) will pay $1,929,071.38 to resolve allegations that it improperly billed government healthcare...more
Courts are continuing to grapple with whether relators can use statistical sampling to prove liability in False Claims Act (FCA) cases. As demonstrated by two recent cases, courts remain skeptical that relators can meet...more
On November 2, 2017, CMS issued a Final Rule that updates payment policies, payment rates, and quality provisions under the Medicare Physician Fee Schedule (PFS) for calendar year (CY) 2018. In addition to establishing...more
On September 26, 2017, the Senate passed the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017. The CHRONIC Care Act amends Title XVIII (Medicare) of the Social Security Act...more
On August 28, 2017, the United States District Court for the Eastern District of Michigan held that a provider must fully exhaust administrative remedies before it can seek a remedy in Federal court against a Medicare...more
On August 2, 2017, CMS issued the Fiscal Year (FY) 2018 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long Term Acute Care Hospital (LTCH) Prospective Payment System Final Rule (Final Rule) that updates...more
On May 18, 2017, the Senate Finance Committee passed the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017, a bipartisan bill focused on improving care for chronically ill...more
On April 11, 2017, the American Association of Nurse Anesthetists (AANA), an organization representing more than 50,000 Certified Registered Nurse Anesthetists (CRNAs), filed a complaint for declaratory and injunctive relief...more
On December 15, 2016, HHS announced an Accountable Care Organization (ACO) initiative for beneficiaries who are dually eligible for Medicare and Medicaid. The Medicare-Medicaid ACO Model (Model) builds on the Medicare Shared...more