On December 27, 2022, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule which, in part, seeks to amend the existing regulations for Medicare Parts A, B, C, and D regarding the standard for when an...more
1/3/2023
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Centers for Medicare & Medicaid Services (CMS) ,
Civil Monetary Penalty ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Medicare Advantage ,
Medicare Part A ,
Medicare Part B ,
Medicare Part C ,
Medicare Part D ,
OIG ,
Overpayment ,
Proposed Rules
The U.S. healthcare industry remains at a crossroads. The healthcare reform legislation passed under President Barack Obama in 2010, officially called the Patient Protection and Affordable Care Act (ACA) but widely referred...more
10/11/2019
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Affordable Care Act ,
Anti-Kickback Statute ,
Centers for Medicare & Medicaid Services (CMS) ,
Certificate of Need ,
Civil Monetary Penalty ,
Co-Management ,
Corporate Practice of Medicine ,
Department of Health and Human Services (HHS) ,
Electronic Protected Health Information (ePHI) ,
False Claims Act (FCA) ,
HCQIA ,
Health Care Providers ,
Health Insurance ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Healthcare Facilities ,
Healthcare Reform ,
HMOs ,
Hospitals ,
HSA ,
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Medical Certification Requests ,
Medical License ,
Medicare ,
Medicare Shared Savings Program ,
Nurses ,
Obama Administration ,
OIG ,
Outpatient Prospective Payment System (OPPS) ,
Physician-Owned Hospitals ,
Preexisting Conditions ,
Stark Law ,
Trump Administration ,
Value-Based Care
In some states, including the Commonwealth of Massachusetts, “site neutrality” for outpatient hospital reimbursement is factoring into state-specific health reform and cost containment initiatives. This potentially goes...more
11/1/2017
/ Affordable Care Act ,
Bipartisan Budget Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Comment Period ,
Employee Retirement Income Security Act (ERISA) ,
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Healthcare Costs ,
Healthcare Facilities ,
Medicare ,
Off-Campus Departments ,
Out of Network Provider ,
Outpatient Services ,
Physicians ,
Proposed Legislation ,
Public Health ,
Stark Law
On Monday, two House committees with oversight over health care and taxation, Energy and Commerce and Ways and Means, released draft reconciliation bills designed to repeal and alter significant portions of the Patient...more
3/9/2017
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Employer Mandates ,
Health Insurance ,
Health Savings Accounts ,
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Legislative Agendas ,
Medicaid ,
Planned Parenthood ,
Proposed Legislation ,
Repeal ,
State Health Insurance Exchanges ,
Tax Penalties
Four years after the issuance of the Proposed Rule and six years after the authorizing statute, CMS has published the much-awaited Final Rule regarding reporting and returning of Medicare Part A and B overpayments (the “Final...more
A New York Federal District Court issued an Opinion and Order, on August 3, 2015, in a closely-watched False Claims Act (FCA) case, Kane v. Healthfirst, Inc. The Court refused to dismiss the whistleblower complaint in which...more
At the core of King v. Burwell is the concern of whether patients will have access to affordable medical care across the country, regardless of how a state chose to implement health care exchanges. In this video, Foley...more
One of the most challenging compliance changes brought about by the Affordable Care Act (ACA) is the provision mandating the reporting and refunding of Medicare and Medicaid overpayments within 60 days of the date they are...more
As part of the Affordable Care Act, Congress outlined the process for providers to return Medicare and Medicaid overpayments. In 2012, CMS proposed the 60-day Refund Rule, as it is commonly known, requiring Medicare providers...more
On July 16, 2013, CMS announced results from the first performance year of the Pioneer Accountable Care Organization (ACO) Model. In the release, CMS reported that the Pioneer ACO participants held Medicare cost increases...more