According to an exclusive report from STAT, sometime last year, federal officials decided to redirect billions in funds from the $175 billion CARES Act’s Provider Relief Fund to the “Operation Warp Speed” (OWS) vaccine...more
On February 19, 2021, President Joe Biden nominated Chiquita Brooks-LaSure to serve as the Administrator for the Centers for Medicare and Medicaid Services (CMS). If confirmed by the Senate, Brooks-LaSure would be the first...more
On January 19, 2021, CMS announced the results of its audit of off-campus outpatient departments claiming the “mid-build” exception following enactment of the 21st Century Cures Act (the Cures Act). Of the 334 providers that...more
On October 20, 2020, CMS approved Nebraska’s Medicaid expansion program – named the “Heritage Health Adult,” or HHA – under Section 1115 of the Social Security Act, creating a new two-tiered system of Medicaid benefits for...more
On August 4, 2020, CMS proposed its annual rule adjusting the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System, as well as changes to quality reporting...more
On July 6, 2020, the House of Representatives Committee on Appropriations released its draft Fiscal Year (FY) 2021 funding bill for the Departments of Labor, Education, and HHS (the Bill), which includes several interesting...more
7/27/2020
/ Advanced Payment Program ,
Biomedical Advanced Research and Development Authority (BARDA) ,
Centers for Disease Control and Prevention (CDC) ,
Centers for Medicare & Medicaid Services (CMS) ,
Coronavirus/COVID-19 ,
Department of Education ,
Department of Health and Human Services (HHS) ,
Department of Labor (DOL) ,
HRSA ,
Medicare ,
National Institute of Health (NIH) ,
Proposed Legislation
On June 9, 2020, HHS announced that it will distribute, through the Health Resources and Services Administration (HRSA), two new rounds of funding to healthcare providers treating low-income and uninsured patients during the...more
Following President Trump’s declaration of a national emergency related to COVID-19 on March 13, 2020, CMS has been swiftly approving states’ requests for flexibilities for their Medicaid programs as they continue to battle...more
On October 31, 2019, CMS issued a final rule with comment period (Final Rule), CMS-1711-FC, updating the payment rates for home health agencies (HHAs) for calendar year (CY) 2020...more
On September 12, 2019, the United States Court of Appeals for the Third Circuit ruled that courts are not required to provide a qui tam relator with an in-person hearing when the government seeks to dismiss a lawsuit under...more
On August 13, 2019, the U.S. Court of Appeals for the District of Columbia Circuit overturned a district court ruling that CMS’s 2017 final rule on the Medicaid DSH program limit calculation violates the Medicaid Act, 42...more
On July 9, 2019, the Department of Justice (DOJ) announced it has indicted and arraigned a New York-based anesthesiologist for her alleged role in a $7 million telemedicine conspiracy to fraudulently bill Medicare, Medicare...more
On June 12, 2019, OIG released two audit reports, A-01-17-00513 and A-01-16-00509, as part of its efforts to improve identification, reporting, and investigation of potential abuse and neglect of Medicare beneficiaries. OIG’s...more
On May 15, 2019, United States District Judge Amy Totenberg ordered HHS to “immediately cease and desist” from further implementing its April 2019 liver allocation policy pending appellate review in Callahan, et al. v. Azar,...more
On December 27, 2018, Judge Rudolph Contreras of the U.S. District Court for the District of Columbia ruled in favor of several associations and hospital plaintiffs, including the American Hospital Association (AHA)...more
On November 13, 2018, the Department of Health and Human Services Office of Inspector General (OIG) issued Advisory Opinion No. 18-14 advising a drug company that its proposal to provide a drug to inpatients without charge...more
On September 27, 2018, the U.S. Supreme Court granted certiorari to review the D.C. Circuit’s decision in favor of hospitals in Allina Health Services, et al. v. Price, 863 F.3d 937 (D.C. Cir. 2017) (Allina II).The Court’s...more
On September 7, 2018, the United States District Court for the District of Columbia vacated CMS’s 2014 Overpayment Rule for Medicare Advantage insurers at 79 Fed. Reg. 29,844, 29,918-25 (the 2014 Overpayment Rule), ruling...more
On August 16, 2018, CMS announced that it is expanding the waiver application standards for new home health agency (HHA) and non-emergency ambulance suppliers in six states with a moratorium on Medicare enrollment. Providers...more
On July 25, 2018, CMS proposed a rule (Proposed Rule) revising factors for determining Medicare payment rates for the Hospital Outpatient Prospective Payment System (OPPS) and the Ambulatory Surgery Center (ASC) Payment...more
On June 1, 2018, CMS issued further guidance for reporting and reviewing final adverse legal actions (ALAs) in provider enrollment applications. In Transmittal 797, which replaces Transmittal 784 to the Medicare Program...more
6/22/2018
/ Adverse Action ,
Centers for Medicare & Medicaid Services (CMS) ,
Change in Ownership ,
Exclusions ,
Health Care Providers ,
Hospitals ,
MACs ,
Medicare ,
Medicare Billing Privileges ,
PECOS ,
Physicians ,
Reporting Requirements ,
Revocation