The U.S. Department of Health and Human Services, Office for Civil Rights (“OCR”), which enforces HIPAA, recently announced a new enforcement initiative, the Risk Analysis Initiative, in conjunction with OCR’s seventh...more
Since the Centers for Medicare & Medicaid Services (“CMS”) paused much of its audit activity during the COVID Public Health Emergency, the most recent rounds of Medicare audit activity may represent the first “look” at the...more
Summer is in full swing, but the U.S. Department of Health and Human Services Office for Civil Rights (“OCR”) is doing anything but taking a vacation from HIPAA. In May and June, OCR issued five resolution agreements...more
A popular saying is that it takes 21 days to form a habit and about 66 days on average for a behavior to become automatic. If that is correct, the three-year period of unprecedented waivers and flexibilities in the provision...more
With 2023 underway, healthcare providers and other “covered entities,” as defined under the Health Insurance Portability and Accountability Act (“HIPAA”), should be mindful of the upcoming annual reporting deadline for small...more
Recently, the U.S. Department of Health and Human Services (“HHS”) Office for Civil Rights (“OCR”) announced three more resolution agreements settling alleged violations of the HIPAA right of access. These agreements bring...more
As the COVID-19 Public Health Emergency (“PHE”) approaches the three-year mark, what initially seemed like the “new” normal seems closer to just plain normal for many healthcare providers. As a result, while the Department of...more
More than 23 million American households — nearly 1 in 5 nationwide — adopted a pet during the COVID-19 pandemic, according to the American Society for the Prevention of Cruelty to Animals (ASPCA). The increasing rates of pet...more
AGG Healthcare attorneys Lanchi Bombalier and Charmaine Mech recently attended the American Health Law Association (AHLA)’s Institute on Medicare and Medicaid Payment Issues in Baltimore, Maryland, from March 23-25, 2022. The...more
On September 1, 2021, as hospice providers continue to grapple with the demands of the ongoing pandemic, the Centers for Medicare & Medicaid Services (CMS) ended its temporary suspension of the Targeted Probe and Educate...more
The U.S. Department of Health and Human Services (HHS), Office of Inspector General (OIG) recently updated its 2021 Work Plan in January to include audits of Medicare Part B and home health telehealth services by OIG’s Office...more
As the end of 2020 approaches, the melody to “Auld Lang Syne” inevitably comes to mind. The meaning of this song is particularly appropriate as we consider what will stay, and what will pass when it comes to telehealth in...more
The financial stakes are often very high for providers when statistical sampling and extrapolation is used to calculate an alleged Medicare overpayment. In post-payment audits involving extrapolation, an actual claims denial...more
CMS Announces Hospice Capitation Rates for Medicare Advantage -
The U.S. Centers for Medicare and Medicaid Services (CMS) recently released the capitation rates for hospice care through the value-based insurance design...more
Exactly one year after the Bipartisan Budget Act of 2018 redefined the statutory definition of “attending physician” to allow physician assistants (PAs) to serve as a hospice attending physician, the Centers for Medicare &...more
If the looming threat of the Review Choice Demonstration which recently began in Illinois was not sufficient to make home health agencies a little anxious, the U.S. Department of Health and Human Services, Office of Inspector...more
The Centers for Medicare and Medicaid Services (CMS) made a number of recent changes to expand the Settlement Conference Facilitation (SCF) process for providers and suppliers mired in the backlog of appeals at the...more
If the looming threat of the Review Choice Demonstration which recently began in Illinois was not sufficient to make home health agencies a little anxious, the U.S. Department of Health and Human Services, Office of Inspector...more
Every year, health lawyers, providers, consultants, and government experts from across the country convene in Baltimore for the American Health Lawyers Association’s Institute on Medicare and Medicaid Payment Issues, the most...more
In July 2018, the Department of Health and Human Services’ Office of Inspector General (OIG) issued a report entitled, Vulnerabilities in the Medicare Hospice Program Affect Quality Care and Program Integrity...more
In preparation for the upcoming expansion of its Settlement Conference Facilitation (SCF) program, the Office of Medicare Hearings and Appeals (OMHA) has directed interested providers and suppliers to review the SCF Expansion...more
On January 9, 2018, the Centers for Medicare and Medicaid Services (CMS) announced details on the new low volume appeal settlement option, which is the latest alternative available to Medicare Part A and Part B providers and...more
On October 13, 2017, the Centers for Medicare and Medicaid Services (CMS) issued a CMS Transmittal to update the Medicare Program Integrity Manual (MPIM) on recent regulatory changes in the Office of Medicare Hearings and...more
On November 17, 2017, the Centers for Medicare and Medicaid Services (CMS) issued a Memorandum to State Survey Agency Directors outlining the process by which Medicare will eliminate existing Home Health Agency (HHA)...more
In the wake of the presidential declaration of the opioid crisis as a national public health emergency, the Department of Health & Human Services (HHS) Office for Civil Rights (OCR) released a new guidance document on October...more