News & Analysis as of

Medicare Federal Health Care Programs (FHCP)

Holland & Hart LLP

FMV for Provider Contracts: Regulatory Standards

Holland & Hart LLP on

As a general rule, healthcare employers are required to pay employed physicians and other contracted providers fair market value (FMV) for their services, but many employers do not understand relevant regulatory standards. ...more

Stevens & Lee

A New Arena for Future Challenges to CMS Regulations – the Overturn of Chevron

Stevens & Lee on

On June 28, 2024, the Supreme Court overruled Chevron, U.S.A., Inc. v. Nat. Res. Def. Council, Inc., and consequently invalidated the “Chevron Deference” — a cornerstone of administrative law since 1984. In the 6-3 decision...more

Foley & Lardner LLP

What Does the End of Chevron Deference Mean for Federal Health Care Programs?

Foley & Lardner LLP on

On June 28, 2024, the Supreme Court rejected the doctrine of Chevron deference in the closely watched case of Loper Bright Enterprises v. Raimondo. In a 6-3 decision, the Court held that Chevron’s rule that courts must defer...more

McDermott+

McDermottPlus Check-Up: April 12, 2024

McDermott+ on

Senate Finance Health Subcommittee Holds Roundtable on Substance Use Disorder Care. Panelists and members discussed how to improve treatment in federal health programs. House Energy & Commerce Health Subcommittee Holds...more

King & Spalding

OIG Issues Favorable Advisory Opinion Regarding the Subsidization of Certain Medicare Cost-Sharing Obligations in the Context of a...

King & Spalding on

On December 21, 2023, the OIG issued a favorable advisory opinion (Advisory Opinion 23-11) regarding the proposed subsidization of certain Medicare cost-sharing obligations in the context of a clinical trial. The...more

Foley & Lardner LLP

CMS’ Making Care Primary (MCP) Model: Applications Due November 30, 2023

Foley & Lardner LLP on

The Centers for Medicare and Medicaid Services’ (CMS) new program Making Care Primary (MCP), is anticipated to begin July 1, 2024. In a previous blog post Foley breaks down major highlights of the new model. On...more

King & Spalding

OIG Issues Advisory Opinion Rejecting Proposal to Offer Free Compatible Hearing Aids to Certain Patients

King & Spalding on

On October 20, 2023, OIG issued a negative Advisory Opinion in response to a proposal from a cochlear implant manufacturer (Requestor) to offer and provide free compatible hearing aids to certain patients (Proposed...more

ArentFox Schiff

OIG Again Concludes That Online Health Care Provider Marketplace Does Not Violate Fraud and Abuse Laws

ArentFox Schiff on

In Advisory Opinion No. 23-04, the US Department of Health and Human Services (HHS) Office of Inspector General (OIG) analyzed certain proposed changes to the functionality of a health care technology company’s online...more

King & Spalding

CMS Announces Increased Scrutiny for Poor-Performing Nursing Facilities

King & Spalding on

On October 21, 2022, CMS announced new actions to increase accountability and scrutiny on nursing homes in the Special Focus Facilities Program (SFF Program), an oversight program for the poorest performing nursing homes in...more

ArentFox Schiff

Investigations Newsletter: SCOTUS Denies Cert In Cases Addressing FCA Pleadings Requirements

ArentFox Schiff on

SCOTUS Denies Cert In Cases Addressing FCA Pleadings Requirements - On Monday, October 17, 2022, the US Supreme Court rejected three petitions asking the Court to resolve a circuit split regarding the Rule 9(b)...more

ArentFox Schiff

OIG Declines To Challenge Debt Cancellation and Restructured Financial Arrangements Between Health System and FQHC “Look-Alike”...

ArentFox Schiff on

In Advisory Opinion 22-17, the US Department of Health and Human Services (HHS) Office of Inspector General (OIG) concluded that a proposed restructuring of a loan and other contractual relationships between a health system...more

Harris Beach PLLC

Gift Cards For Medicare Patients Not Inducements, OIG Opines

Harris Beach PLLC on

The Department of Health and Human Services’ Office of Inspector General (“OIG”) has offered an opinion on providing a gift card to certain Medicare Advantage plan enrollees who complete specific steps in an online patient...more

Harris Beach PLLC

OIG Opinion on Gift Cards for Medicare Patients’ Education as Inducements

Harris Beach PLLC on

This opinion regards the provision of a gift card to certain Medicare Advantage (“MA”) plan enrollees who complete specific steps in an online patient education program....more

King & Spalding

OIG Issues Favorable Advisory Opinion Regarding Non-Profit Efforts to Provide Financial Assistance and Free Items to Individuals...

King & Spalding on

On May 2, 2022, OIG posted Advisory Opinion 22-10, regarding a proposal to provide financial assistance and free items to individuals with a particular disease. The Requestor, a non-profit organization dedicated to providing...more

ArentFox Schiff

Senate Finance Committee Holds Confirmation Hearing For Top Biden HHS Nominees

ArentFox Schiff on

Deputy Secretary and CMS Administrator Picks Would Fill Two Critical Policy Positions - On Thursday, the Senate Finance Committee held a confirmation hearing for two of the most important health policy officials nominated...more

Cozen O'Connor

1st Amendment Win For Credit Card Surcharges| Texas Sues Over Electricity Bills | Dodgy COVID Fees

Cozen O'Connor on

2022 AG Elections- Former South Dakota Attorney General Steps Back into Contention for AG’s Office- •Marty Jackley, who formerly served as U.S. Attorney for South Dakota, South Dakota AG, and President of the National...more

Health Care Compliance Association (HCCA)

Report on Medicare Compliance Volume 29, Number 35. News Briefs: October 2020

Report on Medicare Compliance 29, no. 35 (October 5, 2020) - In a major national enforcement action, the Department of Justice (DOJ) and other federal agencies said Sept. 30 they have charged 345 people, including more...more

King & Spalding

HHS Publishes Additional Terms and Conditions for Provider Relief Fund and FFCRA Payments

King & Spalding on

HHS has published additional Terms and Conditions associated with the acceptance of payments made from the $100 Billion Provider Relief Fund established pursuant to the Coronavirus Aid, Relief, and Economics Security Act...more

Health Care Compliance Association (HCCA)

Report on Medicare Compliance 28, no. 38: News Brief - October 2019 #3

Report on Medicare Compliance 28, no. 38 (Oct. 28, 2019) - - Doctors Hospital of Augusta in Georgia agreed to pay $180,000 in a civil monetary penalty settlement over alleged violations of the Emergency Medical Treatment...more

Bricker Graydon LLP

Post-Acute Providers Beware: Providing Free Staff Or Services To Hospitals Could Land You In Hot Water…Or Worse!

Bricker Graydon LLP on

The federal Anti-Kickback Statute prohibits the practice of knowingly and willfully offering, paying or receiving anything of value to encourage the referral of, or the recommendation of or arranging for the referral of,...more

Baker Donelson

False Claims Act Liability Without Submitting False Claims? Yes, That's a Thing

Baker Donelson on

Most health care providers recognize that submitting a knowingly false claim to a federally funded health care program violates the False Claims Act (FCA). However, it is less well known that indirectly "causing" someone else...more

Cooley LLP

Blog: Final Rule Issued by CMS re: New Enforcement Authorities to Reduce Criminal Behavior in Medicare, Medicaid and CHIP

Cooley LLP on

The Centers for Medicare & Medicaid Services (CMS) issued late last week a final rule with comment period titled, Program Integrity Enhancements to the Provider Enrollment Process (CMS-6058-FC) (Final Rule). The Final Rule is...more

Baker Donelson

OIG's List of Excluded Individuals/Entities – What Employers Need to Know

Baker Donelson on

OIG maintains a list of all currently excluded individuals and entities called the "List of Excluded Individuals/Entities," or LEIE. Covered entities that hire – or continue to employ or work with – an individual or entity on...more

Baker Donelson

Administration Drug Pricing Proposals Could Reduce Provider Payments

Baker Donelson on

As the Trump Administration moves forward with proposed policy changes to address high drug prices, a common theme is emerging: a number of the proposals have the potential to reduce Medicare reimbursement to hospitals and...more

Baker Donelson

OIG Allows Free and Reduced-Cost Services to Strained Caregivers in Advisory Opinion 18-05

Baker Donelson on

In what is becoming a steady trend, the Office of Inspector General (OIG) published another favorable opinion for an arrangement seeking to implement programs that support and engage family members who are increasingly...more

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