On January 21, 2025, according to a memo made available by news outlets, Acting Secretary of HHS, Dr. Dorthy Fink, issued a memo directing the agency’s operating divisions to refrain from most external correspondence,...more
On December 4, 2024, OIG issued its fall 2024 Semiannual Report to Congress (the Report), which provides a comprehensive overview of the agency’s work completed during the reporting period of April 1, 2024, through September...more
12/19/2024
/ Audits ,
Department of Health and Human Services (HHS) ,
Enforcement ,
Information Reports ,
Investigations ,
Medicare ,
Medicare Part B ,
Medicare Part D ,
Nursing Homes ,
OIG ,
Settlement
On July 31, 2024, CMS published a final rule updating the Medicare rates and policies applicable to inpatient psychiatric facilities (IPFs) under the IPF Prospective Payment System (PPS) and the IPF Quality Reporting Program...more
On July 31, 2024, CMS published a final rule updating the Medicare rates and policies applicable to inpatient rehabilitation facilities (IRFs) under the IRF Prospective Payment System (PPS) and the IRF Quality Reporting...more
On July 1, 2024, the HHS Office of Civil Rights (OCR) announced that Pennsylvania-based healthcare system, Heritage Valley Health System (Heritage Valley), has agreed to pay $950,000 to settle potential violations of the...more
On June 18, 2024, the Fourth Circuit issued a 2-1 decision granting the FTC’s request to block the sale of two hospitals in Charlotte, North Carolina. Earlier this month, a federal court in the Western District of North...more
CMS recently published its remedy in response to the Supreme Court’s decision that CMS’s 340B outpatient drug payment policy violated the Medicare statute. Many hospitals that are 340B covered entities will now receive tens...more
On October 10, 2023, Sen. Bernie Sanders (I-Vt.), Chairman of the Senate Health, Education, Labor, and Pensions (HELP) Committee, released a report alleging that certain non-profit hospital systems may not be providing the...more
On August 28, 2023, OIG released a new webpage on managed care oversight, which features the HHS-OIG Strategic Plan for Oversight of Managed Care for Medicare and Medicaid. OIG has designated oversight of managed care as a...more
9/12/2023
/ Department of Health and Human Services (HHS) ,
Enrollment ,
Healthcare ,
Managed Care Contracts ,
MCOs ,
Medicaid ,
Medicare ,
Medicare Advantage ,
OIG ,
Patient Access ,
Payment Systems ,
Strategic Planning
On August 1, 2023, CMS issued its annual Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) Final Rule for FY 2024 (the Final Rule). In the Final Rule, CMS,...more
8/9/2023
/ Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Coronavirus/COVID-19 ,
Department of Health and Human Services (HHS) ,
DSH ,
Final Rules ,
Food and Drug Administration (FDA) ,
Inpatient Prospective Payment System (IPPS) ,
Long-Term Care ,
Medicaid ,
Medicare ,
Rural Health Care Providers ,
Social Security Act ,
Stark Law ,
Waivers
On April 11, 2023, OCR announced that the Notifications of Enforcement Discretion issued under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Health Information Technology for Economic and...more
Last week, the Supreme Court granted review to clarify the scienter requirement in False Claim Act (31 U.S.C. §§ 3729 et seq.) (FCA) cases. This significant decision will affect the scope of FCA liability by addressing what...more
1/20/2023
/ Appeals ,
Drug Pricing ,
Fair Credit Reporting Act (FCRA) ,
False Claims Act (FCA) ,
Fraud ,
Liability ,
Medicaid ,
Medicare Part D ,
Petition for Writ of Certiorari ,
Qui Tam ,
SCOTUS
In response to the COVID-19 Public Health Emergency (PHE), CMS temporarily waived a significant number of Medicare, Medicaid and Children’s Health Insurance Program (CHIP) requirements and conditions of participation pursuant...more