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
On November 6, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) released the most up-to-date, comprehensive, and practical general compliance guidance in decades. The new...more
12/7/2023
/ Centers for Medicare & Medicaid Services (CMS) ,
Compliance ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Fraud and Abuse ,
Health Care Providers ,
Healthcare ,
Investment ,
New Guidance ,
OCR ,
OIG ,
Private Equity
As addressed in the first installment of this three-part series, healthcare providers face potential audits from an increasing number of Medicare and Medicaid contractors. Failing to respond properly can lead to significant...more
Because Medicare and Medicaid claims audit requests can look like routine billing-related correspondence, they can be easy to miss, leading to expensive and potentially catastrophic consequences. Providers, therefore, should...more
The Medicare Physician Fee Schedule Final Rule for Calendar Year 2021 (the Final Rule) issued by the Centers for Medicare & Medicaid Services (CMS) on December 1, 2020, and published in the Federal Register on December 28,...more
1/5/2021
/ Centers for Medicare & Medicaid Services (CMS) ,
Coronavirus/COVID-19 ,
Drug Treatment ,
Final Rules ,
Health Care Providers ,
Medical Coding ,
Medicare ,
Opioid ,
Physician Fee Schedule ,
Physicians ,
Public Health Emergency ,
Reporting Requirements ,
Scope of Treatment ,
Telehealth ,
Vaccinations ,
Verification Requirements
In a coordinated effort, on November 27, 2020, the Centers for Medicare & Medicaid Services (CMS) and the Office of Inspector General (OIG) published final rules to modernize regulations implementing the federal...more
12/22/2020
/ Anti-Kickback Statute ,
Centers for Medicare & Medicaid Services (CMS) ,
Civil Monetary Penalty ,
Final Rules ,
Health Care Providers ,
New Value Exception ,
OIG ,
Pharmacy Benefit Manager (PBM) ,
Physicians ,
Rebates ,
Safe Harbors ,
Stark Law ,
Technology Sector
To address the ongoing national emergency from the COVID-19 pandemic, on March 30, the Centers for Medicare & Medicaid Services (CMS) issued blanket waivers of the federal Physician Self-Referral Law, otherwise known as the...more
On November 15, 2019, the Centers for Medicare & Medicaid Services (CMS) finalized a rule requiring hospitals to make public a list of standard charges for items and services provided by such hospitals (the Rule). (The...more
11/27/2019
/ Centers for Medicare & Medicaid Services (CMS) ,
Disclosure Requirements ,
Final Rules ,
Health Care Providers ,
Health Plan Sponsors ,
Healthcare ,
Healthcare Costs ,
Hospitals ,
Physicians ,
Price Transparency ,
Proposed Rules ,
Public Health Service Act
In a coordinated effort, CMS and the Office of Inspector General (OIG) published proposed rules to modernize regulations implementing the federal physician-self referral law, commonly referred to as the “Stark Law” (Stark),...more
10/30/2019
/ Anti-Kickback Statute ,
Beneficiary Inducement ,
Centers for Medicare & Medicaid Services (CMS) ,
Civil Monetary Penalty ,
Comment Period ,
Department of Health and Human Services (HHS) ,
EHR ,
Health Care Providers ,
OIG ,
Proposed Rules ,
Public Comment ,
Safe Harbors ,
Stark Law ,
Value-Based Care
The U.S. Court of Appeals for the Third Circuit recently issued a False Claims Act (FCA) decision calling into question productivity-based physician compensation structures under the Stark Law, in reliance on a controversial...more
10/15/2019
/ Appeals ,
Centers for Medicare & Medicaid Services (CMS) ,
Dismissals ,
False Claims Act (FCA) ,
Health Care Providers ,
Hospitals ,
Physician Compensation Arrangements ,
Physicians ,
Pleading Standards ,
Provider Payments ,
Relators ,
Reversal ,
Stark Law ,
Tuomey
On July 29, 2019, the Centers for Medicare & Medicaid Services (CMS) took the first steps toward welcoming opioid treatment programs (OTPs) into the Medicare program and expanding Medicare coverage of opioid use disorder...more
8/14/2019
/ Centers for Medicare & Medicaid Services (CMS) ,
Drug Treatment ,
Food and Drug Administration (FDA) ,
HCPCS ,
Medicare Part D ,
Opioid ,
Physician Fee Schedule ,
Prescription Drugs ,
Proposed Rules ,
Public Comment ,
SAMHSA
Recent opinions by the Fifth Circuit, the Northern and Southern Districts of Texas, and the District of South Carolina offer hope to providers seeking relief from substantial monetary recoupments during the Medicare appeals...more
9/28/2018
/ Administrative Appeals ,
Administrative Law Judge (ALJ) ,
Administrative Remedies ,
Audits ,
Centers for Medicare & Medicaid Services (CMS) ,
Complaint Procedures ,
Health Care Providers ,
Injunctive Relief ,
Irreparable Harm ,
Medicare ,
Medicare Claims Appeals Process ,
Motion for Reconsideration ,
OMHA ,
Overpayment ,
Physician Medicare Reimbursements ,
Recoupment ,
Redeterminations ,
TRO
On July 17, 2018, the U.S. House of Representatives' Ways and Means Committee Subcommittee on Health ("Subcommittee") expressed its commitment to modernizing the Stark Law during a hearing in which industry and government...more
7/19/2018
/ ACOs ,
Affordable Care Act ,
Alternative Payment Models (APM) ,
Anti-Kickback Statute ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Health Care Providers ,
Hospitals ,
Medicare Access and CHIP Reauthorization (MACRA) ,
OIG ,
Request For Information ,
Stark Law ,
Ways and Means Committee
In January 2018, Centers for Medicare & Medicaid Services (CMS) announced additional information regarding a new Low Volume Appeals (LVA) settlement option and an expanded Settlement Conference Facilitation (SCF) as part of...more
4/13/2018
/ Administrative Law Judge (ALJ) ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Low Volume Appeals Settlement Options (LVA) ,
MACs ,
Medicare ,
Medicare Appeals Council ,
Medicare Claims Appeals Process ,
Medicare Part A ,
Medicare Part B ,
OMHA