News & Analysis as of

Office of the Inspector General MedPAC

King & Spalding

CMS Solicits Comments on Improving Medicare Advantage Data Transparency

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On January 25, 2024, CMS released a Request for Information (RFI) seeking public input on how it can enhance and increase transparency of Medicare Advantage (MA) data. CMS says that the RFI “builds on our existing MA data...more

Husch Blackwell LLP

Telehealth Flexibilities Extended to Late 2022 and Likely Beyond

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Recent legislative changes indicate that Congress is committed to continuing to allow patients to access telehealth services after the COVID-19 public health emergency (PHE) ends, but it is gathering more information before...more

Health Care Compliance Association (HCCA)

Report on Medicare Compliance Volume 30, Number 11. News Briefs: March 2021 #2

Report on Medicare Compliance 30, no. 11 (March 22, 2021) - University Medical Center of Southern Nevada has agreed to pay $128,820 in a civil monetary penalty settlement that stemmed from a self-disclosure. According to...more

Hogan Lovells

2020 final price reporting developments: stimulus legislation, 340B contract pharmacy Advisory Opinion

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As we begin the new year, we wanted to highlight two final developments from December 2020: First, on Dec. 27, 2020, the stimulus legislation H.R. 133, the Consolidated Appropriations Act of 2021 (link), Pub. L. 116‑260...more

Sheppard Mullin Richter & Hampton LLP

CMS Finalizes 2020 Hospice Rule: Big Changes Coming

On August 6, 2019, CMS finalized its 2020 hospice rule, including adopting, without substantial modification, two controversial and material changes to the hospice benefit: Rebasing payment rates to shift about $500...more

Foley & Lardner LLP

OIG Report: CMS Paid Practitioners for Telehealth Services That Did Not Meet Medicare Requirements

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The Office of Inspector General (OIG) at the Department of Health & Human Services (HHS) just published a new report on OIG’s review of Medicare payments for telehealth services. The objective of the OIG review was to...more

Holland & Knight LLP

White House Unveils Proposal on Drug Pricing

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On Feb. 9, 2018, the Trump Administration released a 30-page report analyzing domestic and global factors influencing drug pricing. The report by the Council of Economic Advisers (CEA) is expected to inform the HHS' Fiscal...more

Jones Day

Legislation, Lawsuit Cloud Future of 340B Program Payment Rate Reductions

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The Situation: A Final Rule published by the Centers for Medicare & Medicaid Services carries a provision that reduces reimbursement for most 340B Program drugs dispensed by disproportionate share hospitals and rural referral...more

Mintz - Health Care Viewpoints

Six Questions and Answers About CMS’ Recommended Changes to 340B Medicare Reimbursement

In March, I posted about the Uncertain Future of the 340B Drug Discount Program.  When opining about What Could Happen Next I speculated about possible changes to government reimbursement for 340B drugs “so that government...more

McDermott Will & Emery

OIG Issues Report on Provider-Based Facilities, Urges CMS to Make Changes

McDermott Will & Emery on

In Depth - On June 16, 2016, the US Department of Health and Human Services Office of Inspector General (OIG) posted a report examining the Centers for Medicare & Medicaid Services’ (CMS’s) oversight of billing by...more

Hinshaw & Culbertson LLP

Significant Hospital Related Mid-Year Updated OIG Review Activities

This is the second of three alerts discussing the mid-year update to the Fiscal Year 2016 Work Plan issued by the Office of Inspector General (OIG). In the first alert we discussed the top management performance challenges...more

Cadwalader, Wickersham & Taft LLP

Trove of SNF Claims Data Released By CMS – Ready for Mining By Auditors and Whistleblowers

Over recent years, the Federal government has trained its sights on potential billing abuses in the Medicare Part A program for Skilled Nursing Facilities (“SNFs”) in the provision of rehabilitation therapy services. The...more

Foley & Lardner LLP

Potential Part B Drug Payment Cuts for 340B Hospitals

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The influential Medicare Payment Advisory Commission (MedPAC) has voted to recommend to Congress in its March report that Medicare Part B drug payment rates for 340B drugs be reduced by 10 percent for hospitals participating...more

Polsinelli

Provider-Based Status: A Quiet Casualty of the Bipartisan Budget Act

Polsinelli on

Without fanfare or any significant discussion, the Bipartisan Budget Act (Act) contains the first legislative action related to provider-based status—and it is a sweeping action with negative financial consequences to many...more

Foley & Lardner LLP

Budget Bill Aims to Kill Any New Off-Campus Provider-Based Facilities

Foley & Lardner LLP on

Legislation being drafted as part of a budget deal between members of Congress and the White House includes language that will significantly alter the future of hospital-based outpatient care. The “discussion draft” of the...more

King & Spalding

Senate Aging Committee Hearing on Hospital Observation Stay Policies

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On May 20, 2015, the Senate Special Committee on Aging held a hearing entitled “Challenging the Status Quo: Solutions to the Hospital Observation Stay Crisis.” Chairman Susan Collins (R-ME) and Ranking Member Claire...more

King & Spalding

MedPAC Issues March 2015 Report to Congress on Medicare Payment Policies

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On March 13, 2015, the Medicare Payment Advisory Commission (MedPAC) issued its annual report to the Congress on Medicare payment policies (Report). The Report includes recommendations for inflation updates and payment...more

Polsinelli

Health Reform + Related Health Policy News Update - January 16, 2013

Polsinelli on

In This Issue: - Fiscal Cliff Deal Lengthens Medicare Overpayment Recovery Period - Cutting Medicaid Provider Tax May Shift Costs to States, CRS Finds - MedPAC Finalizes Payment Recommendations, GAO Solicits...more

King & Spalding

OIG Finds That More Than $1 Billion in Inappropriate Medicare Payments Were Made to SNFs in 2009

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The OIG recently issued a report (OEI-02-09-00200) concerning improper skilled nursing facility (SNF) Medicare payments in calendar year 2009 (the Report). The OIG reviewed a stratified random sample of SNF claims from 2009...more

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