The Hospital Readmissions Reduction Program (HRRP) is a Medicare value-based purchasing program that reduces payments to hospitals with excess readmissions. This performance program penalizes hospitals up to three percent of...more
On May 28, 2021, OIG released its Semiannual Report to Congress (the Report). The Report describes OIG’s work during the 6-month semiannual reporting period of October 1, 2020, through March 31, 2021 (the Semiannual Reporting...more
6/3/2021
/ Audits ,
Centers for Medicare & Medicaid Services (CMS) ,
Coronavirus/COVID-19 ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
Fraud ,
Healthcare Fraud ,
Medicaid ,
Medicare ,
Medicare Part B ,
Medicare Part D ,
OIG ,
Opioid
From December 23, 2020 through December 31, 2020, the OIG issued several advisory opinions. The advisory opinions analyzed (1) a program for a pharmaceutical manufacturer to provide financial assistance to certain patients,...more
1/8/2021
/ Advisory Opinions ,
Anti-Kickback Statute ,
Financial Assistance Policies ,
Food and Drug Administration (FDA) ,
Home Health Agencies ,
Manufacturers ,
Medicare ,
OIG ,
Pharmaceutical Industry ,
Prescription Drugs ,
Preventive Health Care ,
REMS ,
Skilled Nursing Facility
On December 2, 2020, CMS issued the calendar year (CY) 2021 Medicare Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule. Through these policy changes, CMS seeks to...more
On November 1, 2020, CMS and the Department of the Treasury approved Georgia’s request for a 1332 State Relief and Empowerment waiver (1332 waiver), permitting the state to implement a new healthcare plan to address growing...more
On September 2, 2020, CMS issued the fiscal year (FY) 2021 final rule for the hospital inpatient prospective payment system (IPPS) and long-term care hospital (LTCH) prospective payment system (the Final Rule). This article...more
9/11/2020
/ Bad Debt ,
Centers for Medicare & Medicaid Services (CMS) ,
DSH ,
Dual Eligibility ,
EHR ,
Final Rules ,
Financial Assistance Policies ,
Graduate Medical Education ,
Inpatient Prospective Payment System (IPPS) ,
Long Term Care Facilities ,
Medicaid ,
Medical Reimbursement ,
Medicare ,
Medicare Advantage ,
Patient Prospective Payment System
On July 27, 2020, HHS issued a press release indicating that Lifespan Health System Affiliated Covered Entity (Lifespan), a non-profit health system in Rhode Island, reached a settlement with the Office for Civil Rights...more
On March 30, 2020, CMS issued additional Section 1135 blanket waivers to provide the American healthcare system with additional flexibility to respond to the COVID-19 pandemic. CMS is authorized under Section 1135 of the...more
4/8/2020
/ 1135 Waivers ,
Ambulance Providers ,
Centers for Medicare & Medicaid Services (CMS) ,
Children's Health Insurance Program (CHIP) ,
Department of Health and Human Services (HHS) ,
Health Care Providers ,
Healthcare ,
Hospice ,
Hospitals ,
Medicaid ,
Medical Devices ,
PACE ,
Public Health ,
Public Health Emergency ,
Telehealth
On March 13, 2020, President Trump declared the coronavirus pandemic a national emergency, invoking powers under the National Emergency Act and the Stafford Act. The President’s declaration, coupled with Secretary Azar’s...more
On January 21, 2020, the Centers for Disease Control and Prevention (“CDC”) confirmed the first case of a new coronavirus, “2019-nCoV” or “Wuhan coronavirus,” in the United States. The patient—like the other four, confirmed...more
1/28/2020
/ Centers for Disease Control and Prevention (CDC) ,
Crisis Management ,
Emergency Response ,
Emergency Rooms ,
Employee Training ,
Health Care Providers ,
Health Insurance Portability and Accountability Act (HIPAA) ,
HIPAA Breach ,
Hospitals ,
Personal Protective Equipment ,
Public Health ,
Risk Assessment
On December 17, 2019, CMS and HRSA announced two proposed rules intended to: (1) enforce accountability from Organ Procurement Organizations (OPO) for their performance; and (2) promote more organ donations from living...more
CMS has been working with the states to improve Medicaid and CHIP data collection regarding beneficiaries, providers, fee-for-service claims, managed care claims and liable third parties. To improve the monitoring of these...more
On February 11, 2019, CMS issued a proposed rule, to improve access to electronic health information (the Proposed Rule). The Proposed Rule results from the 21st Century Cures Act (the Cures Act), in which CMS and the Office...more
2/28/2019
/ 21st Century Cures Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Children's Health Insurance Program (CHIP) ,
Comment Period ,
Data-Sharing ,
Electronic Medical Records ,
Electronic Protected Health Information (ePHI) ,
Health Care Providers ,
Hospitals ,
Medicaid ,
Medicare ,
Medicare Advantage ,
Patient Privacy Rights ,
Proposed Rules
On December 14, 2018, the Department of Health and Human Services (HHS), Office for Civil Rights (OCR), issued a Request for Information (RFI), for assistance in identifying provisions of the Health Insurance Portability and...more