On September 30, 2024, a federal district court in Florida held the qui tam enforcement provision of the False Claims Act (“FCA”), which permits private citizens to pursue actions in the name of and on behalf of the...more
10/11/2024
/ Appointments Clause ,
Article II ,
False Claims Act (FCA) ,
Federal Rules of Civil Procedure ,
Florida ,
Medicare ,
Officers of the United States ,
Qui Tam ,
Relators ,
SCOTUS ,
Take Care Clause ,
United States ex rel Polansky v Executive Health Resources Inc
On August 2,2024, the Fifth Circuit affirmed the vacatur of federal rulemaking related to the No Surprises Act’s (NSA) Independent Dispute Resolution (IDR) process. The Court held that the No Surprises Act does not permit the...more
8/15/2024
/ Article III ,
Centers for Medicare & Medicaid Services (CMS) ,
Chevron Deference ,
Department of Health and Human Services (HHS) ,
Dispute Resolution ,
Final Rules ,
New Regulations ,
No Surprises Act (NSA) ,
Out of Network Provider ,
Payment Systems ,
Vacated
On March 18, 2024, thirty-nine (39) members of the United States House of Representatives sent a letter urging federal agencies to finalizing rulemaking regarding the implementation of the No Surprises Act. The letter,...more
On March 12, 2024, the Judicial Conference of the United States, the advisory body for the federal judiciary, announced a new policy to discourage “judge-shopping.” This new policy will require random judicial assignment...more
On November 28, 2023, the Departments of Health and Human Services, Labor, and the Treasury (the Departments) issued two sets of FAQs on aspects of the No Surprises Act (NSA) Independent Dispute Resolution Process (IDR...more
On October 27, 2023, the Departments of HHS, Labor, and Treasury and the Office of Personnel Management (the Departments) released a proposed rule updating the payor-provider dispute resolution process under the federal No...more
On August 24, 2023, Judge Kernodle of the Eastern District of Texas issued a fourth judgment overturning additional aspects of the No Surprises Act (NSA) rulemaking and guidance. This latest decision vacated aspects of...more
Last week, a number of developments arose stemming from the various lawsuits challenging the No Surprises Act. First, in response to the Eastern District of Texas’ order vacating the administrative fee guidance for the...more
On August 3, 2023, the Texas Medical Association (TMA) was granted summary judgment in its challenge to (1) the $350 CY 2023 administrative fee for the No Surprises Act’s Independent Dispute Resolution (IDR) process and (2) a...more
On July 6, 2023, the HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) released the first of five required annual reports on the impact of the No Surprises Act (NSA) on health care markets (the Report)....more
7/21/2023
/ Billing ,
Department of Health and Human Services (HHS) ,
Dispute Resolution ,
Health Care Providers ,
Health Insurance ,
Healthcare ,
Healthcare Reform ,
No Surprises Act (NSA) ,
Out of Network Provider ,
Out-of-Pocket Expenses ,
Surprise Medical Bills
House Republicans have announced their intent to cut federal funding for training new pediatricians to hospitals that perform gender-affirming care on minors. The proposed bill, sponsored by Rep. Dan Crenshaw (R-Texas), would...more
On May 10, 2023, HHS announced that many telehealth and teleprescribing flexibilities will remain in place after the end of the COVID-19 Public Health Emergency (PHE) on May 11, 2023. Congress extended many telehealth...more
5/22/2023
/ ACOs ,
Children's Health Insurance Program (CHIP) ,
Consolidated Appropriations Act (CAA) ,
Coronavirus/COVID-19 ,
DEA ,
Department of Health and Human Services (HHS) ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Medicaid ,
Medicare Advantage Organizations (MAOs) ,
OCR ,
Opioid ,
Public Health Emergency ,
SAMHSA ,
Telehealth
On March 28, 2023, the Sixth Circuit issued a decision interpreting the definition of remuneration under the Anti-Kickback Statute (AKS) and the level of causation necessary for a False Claims Act (FCA) action to be premised...more
On January 18, 2023, CMS issued a Quality, Safety & Oversight Group memorandum announcing its initiative to improve nursing home safety and transparency. Specifically, CMS will conduct audits to determine whether nursing...more
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
On August 19, 2022, the Departments of Health and Human Services, Labor, and the Treasury (the Departments) issued a long-awaited final rule (the Final Rule) on the Independent Dispute Resolution (IDR) Process under the No...more
On July 26, 2022, LifeNet was granted summary judgment in its challenge to portions of the second set of implementing regulations for the Independent Dispute Resolution (IDR) process for air ambulance providers under the No...more
8/4/2022
/ Administrative Procedure Act ,
Appeals ,
Arbitration ,
Department of Health and Human Services (HHS) ,
Dispute Resolution ,
OMB ,
Out of Network Provider ,
Summary Judgment ,
Surprise Medical Bills ,
Texas ,
Vacated
On July 5, 2022, OIG posted Advisory Opinion No. 22-15, regarding a proposal by two universities to provide medical care and financial assistance to veterans with mild-to-moderate traumatic brain injuries and associated...more
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
On February 23, 2022, the Texas Medical Association was granted summary judgment in its challenge to portions of the second set of implementing regulations that implement the No Surprises Act’s Independent Dispute Resolution...more
Last week, OIG released a report analyzing trends in the last decade relating to Medicare payments for hospice beneficiaries outside of the hospice per diem. In the report, OIG notes that CMS has taken the position that...more
Last week, HHS announced the distribution of more than $2 billion in Provider Relief Fund (PRF) Phase 4 General Distribution payments. These payments bring the Phase 4 distribution total to approximately $11 billion of the...more
The No Surprises Act (the Act), enacted December 27, 2021, will take effect on January 1, 2022. The No Surprises Act puts into place important patient protections from surprise medical bills, while imposing significant...more
12/23/2021
/ Affordable Care Act ,
Department of Health and Human Services (HHS) ,
Disclosure Requirements ,
Employee Retirement Income Security Act (ERISA) ,
Health Care Providers ,
Medicaid ,
Medicare ,
Medicare Advantage ,
No Surprises Act (NSA) ,
Reimbursements ,
Surprise Medical Bills
On November 5, 2021, 152 members of the U.S. House of Representatives submitted a letter to the Secretaries of the Departments of Health and Human Services, Labor, and the Treasury (the Departments) urging the Departments to...more
On July 29, 2021, CMS issued final rules for FY 2022 in its yearly update to Medicare payment policies under the Skilled Nursing Facility (SNF) prospective payment system (PPS), Inpatient Rehabilitation Facilities (IRFs) PPS,...more
8/5/2021
/ Centers for Disease Control and Prevention (CDC) ,
Centers for Medicare & Medicaid Services (CMS) ,
Coronavirus/COVID-19 ,
DMEPOS ,
Healthcare Workers ,
Medicare ,
Patient-Driven Payment Model (PDPM) ,
Prospective Payment System (PPS) ,
Psychiatric Hospitals ,
Public Health Emergency ,
Rehabilitation Act ,
Skilled Nursing Facility