A recent HHS OIG review of 2014 data on fraud allegations found that significant challenges were limiting the States’ use of payment suspensions, even in the face of what CMS determined were credible allegations of provider...more
Almost a decade ago, California submitted a State plan amendment (SPA) to the Centers for Medicare and Medicaid Services (CMS) that would retroactively implement a ten-percent rate reduction in outpatient services provided to...more
CMS issued a final rule on October 4, 2016, prohibiting pre-dispute arbitration agreements between long-term care facilities and residents. As reported here, on November 7, 2016, a Federal judge issued a preliminary...more
Mark Miller, MedPAC’s Executive Director, testified before the House Ways and Means Committee last week to discuss MedPAC’s Annual Report to Congress, Medicare Payment Policy, which was released March 15, 2017. ...more
Even as President Trump and Congress work toward repealing some or all of the Affordable Care Act (ACA), CMS announced a final rule aimed at market stabilization of the Health Benefit Exchanges that are the cornerstone of the...more
Over 100 health care companies – including providers, insurers, biopharmaceutical companies, professional associations and consumer groups – joined to write the Trump administration to urge him to “continue focusing on...more
On December 7, 2016, the HHS OIG issued a long-awaited final rule providing additional safe harbors under the federal anti-kickback statute (AKS) and changed the definition of “remuneration” in the civil monetary penalty...more
In September, CMS announced a final rule that bans pre-dispute binding arbitration agreements related to care received in long-term care facilities. Among other things, the rule preserves the right of patients and their...more
11/18/2016
/ Arbitration ,
Arbitration Agreements ,
Binding Arbitration ,
Centers for Medicare & Medicaid Services (CMS) ,
Contract Terms ,
Health Care Providers ,
Healthcare ,
Long Term Care Facilities ,
Long-Term Care ,
Medicaid ,
Medicare ,
Nursing Homes ,
Skilled Nursing Facility
The Office of Inspector General (OIG) issued a report on September 7, 2016 urging CMS to overhaul the way it pays for drugs infused through durable medical equipment (DME) provided to Medicare Part B beneficiaries. Current...more
The U.S. Department of Justice (DOJ), joined by attorneys general from several states, filed a lawsuit last Thursday in the U.S. District Court for the District of Columbia seeking to block two major mergers between health...more