On January 3, 2022, the U.S. Court of Appeals for the Fifth Circuit Court reversed the decision of the District Court for the Western District of Louisiana dismissing for lack of jurisdiction a Medicare provider’s suit...more
On November 30, 2021, the U.S. District Court for the Western District of Louisiana halted the Biden administration’s vaccine mandate for healthcare workers at certified Medicare and Medicaid providers and suppliers. The...more
On July 7, 2021, the U.S. District Court for the District of Columbia ruled in favor of HHS and upheld HHS’s 2013 rule readopting its policy of including Part C days in the Medicare fraction of the disproportionate share...more
Hospitals and other health care providers work hard to eliminate billing and coding errors, but mistakes still happen. When those mistakes occur, health plans sometimes try to capitalize on the error by using it as a basis to...more
On May 5, 2021, OIG issued guidance on its COVID-19 Administrative Enforcement FAQs page stating that an ambulance provider or supplier waiving or discounting Medicare beneficiary cost-sharing obligations presents a low risk...more
5/14/2021
/ Ambulance Providers ,
Anti-Kickback Statute ,
Beneficiaries ,
Coronavirus/COVID-19 ,
Department of Health and Human Services (HHS) ,
Emergency Medical Services (EMS) ,
Enforcement Actions ,
Medicare ,
OIG ,
Public Health Emergency ,
Reimbursements ,
Social Security Act ,
Waivers
On March 15, 2021, the Medicare Payment Advisory Commission (MedPAC) released its Medicare Payment Policy report to Congress updating payment recommendations for providers paid under Medicare’s traditional fee-for-service...more
On November 2, 2020, CMS issued a final rule updating Medicare payment policies and rates under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services for 2021. Under the final rule,...more
On October 5, 2020, the U.S. Supreme Court declined to review a case questioning the materiality standard for Medicare fraud cases under the False Claims Act (FCA). The case involved allegations that Lawrence Memorial...more
On September 3, 2020, HHS announced the details of a $2 billion Provider Relief Fund (PRF) performance-based incentive payment distribution to qualifying nursing facilities. Unlike previous distributions to nursing...more
On July 30, 2020, HHS released several new Frequently Asked Questions (FAQs) regarding payments distributed to providers under the Coronavirus Aid, Relief, and Economic Security (CARES) Act Provider Relief Fund. Providers...more
8/11/2020
/ Children's Health Insurance Program (CHIP) ,
Coronavirus/COVID-19 ,
Department of Health and Human Services (HHS) ,
FEMA ,
Health Care Providers ,
Home and Community Based Services (HCBS) ,
Medicaid ,
Paycheck Protection Program (PPP) ,
Provider Relief Fund ,
Relief Measures ,
SBA
The IRS announced, through its FAQ page, that for-profit healthcare providers, including hospitals and physician practices, will have to pay federal income taxes on any distributions they receive from the Public Health and...more
7/24/2020
/ CARES Act ,
Coronavirus/COVID-19 ,
Health Care Providers ,
Hospitals ,
Income Taxes ,
IRS ,
New Guidance ,
Paycheck Protection Program and Health Care Enhancement Act ,
Physicians ,
Popular ,
Provider Relief Fund
On June 22, 2020, CMS issued a press release calling for a renewed national commitment to value-based payment models for healthcare providers rather than fee-for-service models. The proclamation came as CMS also released...more
On April 7, 2020, CMS announced it has approved nearly $34 billion in requests from over 17,000 healthcare providers and medical equipment suppliers through the expansion of the Accelerated and Advance Payment Program (the...more
Health plan contracts typically include binding arbitration clauses, and the health plan typically specifies which arbitration association it prefers to use. If the arbitration association makes millions of dollars resolving...more
On January 21, 2020, the U.S. District Court for the Northern District of Georgia granted in part and denied in part a motion challenging a new HHS policy for allocating livers to transplant patients in the United States. The...more
On October 4, 2019, the DOJ announced a $6.65 million settlement with a Southern California ophthalmology group, its former CEO, and several physicians, to resolve False Claims Act (FCA) allegations related to fraudulent...more