Hospice Audit Series | It's That Time of Year Again: Quality Data Reporting Determinations Raise New and Recurring Issues
On October 28, 2025, HHS Office of Inspector General (OIG) posted an audit report finding that Medicare improperly paid suppliers $22.7 million over seven years for durable medical equipment, prosthetics, orthotics, and...more
McDermott+ is pleased to bring you Regs & Eggs, a weekly Regulatory Affairs blog by Jeffrey Davis. October 23, 2025 – We in the health policy world have been kept on our toes lately as the Centers for Medicare & Medicaid...more
Key Takeaways: The Centers for Medicare & Medicaid Services has instructed Medicare contractors to hold payment for telehealth claims dated Oct. 1, 2025, or later....more
During the COVID-19 public health emergency, Medicare relaxed many of its longstanding telehealth restrictions to enable broader access to virtual care. These flexibilities included waiving geographic limitations, permitting...more
Our Health Care Group reviews a new five-year CMS demonstration project requiring ambulatory surgical centers (ASCs) in 10 states to obtain approval before performing certain procedures....more
This issue of McDermott’s Healthcare Regulatory Check-Up highlights key regulatory and enforcement activity for March 2025. This month features: - Noteworthy enforcement actions demonstrating that the Anti-Kickback Statute...more
Last week, OIG’s Office of Audit Services released its latest report on Medicare Administrative Contractors’ (MACs) compliance with Medicare cost report oversight requirements. The report, which is titled Medicare...more
The Centers for Medicare & Medicaid Services (CMS) recently announced it will require off-cycle revalidation of skilled nursing facilities (SNFs) through the end of 2024. During this process, CMS will collect ownership,...more
On June 27, 2024, the Ensuring Access to Breakthrough Products Act of 2024 (H.R. 1691) was marked up and reported out of the House Ways and Means Committee. This action brings Medicare beneficiaries one step closer to timely...more
Prescription drug fraud has long been a focus for government regulators, but it has taken on new significance in the wake of America’s opioid crisis. The U.S. Department of Justice (DOJ), Department of Health and Human...more
Recognizing the ongoing impact of the cyberattack experienced by Change Healthcare/Optum on February 21, 2024, the Centers for Medicare & Medicaid Services (CMS) announced over the weekend that it will allow Part A providers...more
Editor’s Note: PYA and Foley & Lardner hosted the 6th Annual “Let’s Talk Compliance” two-day Virtual Conference on January 18 and 19, 2024. Panelists included Foley & Lardner attorneys and PYA experts. The event was hosted by...more
Since the Centers for Medicare & Medicaid Services (“CMS”) paused much of its audit activity during the COVID Public Health Emergency, the most recent rounds of Medicare audit activity may represent the first “look” at the...more
On July 27, 2023, CMS issued a final rule (Final Rule) which revises Medicare policies and rates for the Inpatient Psychiatric Facility (IPF) Prospective Payment System (PPS) for the 2024 fiscal year (FY 2024). Among other...more
Effective July 13, 2023, the Centers for Medicare & Medicaid Services (“CMS”) announced a period of enhanced oversight for new hospices in Arizona, California, Nevada, and Texas. According to the Medicare Learning Network...more
Along with its calendar year (CY) 2024 Medicare Outpatient Prospective Payment System (OPPS) proposed rule, the Centers for Medicare & Medicaid Services (CMS) have also published the long-awaited proposal to remediate the...more
If you are a healthcare provider enrolled with Medicare and Medicaid, it is imperative that you know the governmental agencies’ expectations for compliant billing and understand that the agencies constantly monitor and audit...more
On July 7, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to implement a remedy in response to last year’s Supreme Court decision finding the Medicare Part B payment policy for hospitals in the 340B...more
On June 8, 2023, the Centers for Medicare & Medicaid Services (CMS) announced a new nationwide audit of all skilled nursing facilities (SNF) and Hospital swing bed providers that submit claims for reimbursement to Medicare...more
The explosive growth in telehealth over the past five years has resulted from, among other things, the Centers for Medicare & Medicaid Services’ (CMS) extension of Medicare reimbursement to remote monitoring of patients by...more
Medicare telehealth post-Public Health Emergency (PHE): With the COVID-19 PHE concluding on May 11, 2023, many of the telehealth flexibilities the Centers for Medicare & Medicaid Services (CMS) implemented during the PHE will...more
On March 16, 2023, CMS issued Transmittal 11904, directing its contractors to adjust hospitals’ nursing and allied health education (NAH) payments associated with services furnished to Medicare Advantage (MA) enrollees. ...more
On March 16, 2023, CMS issued Change Request 12669, which contains instructions for Medicare Administrative Contractors (MACs) to begin the process of retroactively reimbursing DSH hospitals for inpatient days attributable to...more
A recent multijurisdictional contractor advisory committee (CAC) meeting held by six of the seven Medicare Administrative Contractors (MACs) gave stakeholders an initial opportunity to provide feedback on the strength of...more
+Dx Forum 2023 is the premier gathering for the laboratory diagnostics community. Join us for insightful discussion about the latest regulatory and reimbursement developments....more