Matthew Westbrook on Centers for Medicare & Medicaid Services (CMS)

CMS Proposes Additional Modifications to the Overpayment Rule Relating to the Deadline for Reporting and Returning Overpayments

In the context of Medicare Advantage (“MA”) reform initiatives, we previously addressed the Centers for Medicare & Medicaid Services’ (“CMS”) December 27, 2022 proposal to amend its regulations set forth at 42 C.F.R. §...more

8/6/2024 / Centers for Medicare & Medicaid Services (CMS) , False Claims Act (FCA) , Final Rules , Healthcare Fraud , Investigations , Medicare Advantage , Medicare Part D , Overpayment , Physician Fee Schedule , Proposed Rules , Regulatory Reform , Reporting Requirements , Voluntary Disclosure

The Supreme Court’s Ruling Narrows Available FCA Scienter Defenses

In a unanimous opinion, the United States Supreme Court (“Court”) recently held that the False Claims Act’s (“FCA”) scienter requirement refers to a defendant’s knowledge and subjective beliefs, rather than what a...more

6/20/2023 / Centers for Medicare & Medicaid Services (CMS) , False Claims Act (FCA) , Medicaid , Medicare , Misrepresentation , Safeco Insurance Co of America v Burr , Scienter , SCOTUS , Subjective Standard , Vacated

Medicare Advantage 2024 Rate Announcement – Further Impacts to Risk Adjustment

On Friday, March 31, 2023, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2024 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies (Rate Announcement). This Rate...more

4/4/2023 / Centers for Medicare & Medicaid Services (CMS) , False Claims Act (FCA) , Fee-for-Service , Medicare , Medicare Advantage , Medicare Advantage Organizations (MAOs) , Medicare Part C , Medicare Part D , MedPAC , Social Security Act

President Biden Announces the End of the COVID-19 Emergencies: The Health Care Industry Has Less Than Four Months to Prepare

After multiple extensions over the past three years, on Monday, January 30, 2023, President Biden announced that the COVID-19 national emergency and public health emergency (“PHE”) will officially end on May 11, 2023....more

2/3/2023 / Biden Administration , Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Extensions , Health Care Providers , Healthcare , Healthcare Facilities , Public Health Emergency , Reimbursements

The Supreme Court Denies Petition Challenging CMS’s Overpayment Rule

This past week, the Supreme Court of the United States (Supreme Court) denied UnitedHealthcare Insurance Company’s (UnitedHealthcare) petition for a writ of certiorari (Petition) challenging, in part, the Centers for Medicare...more

6/27/2022 / Centers for Medicare & Medicaid Services (CMS) , Denial of Certiorari , False Claims Act (FCA) , Fee-for-Service , Health Insurance , Healthcare , Medicare Advantage , Overpayment Recovery Time Limits , SCOTUS

Health Care Providers on Alert: Two Hospitals Penalized for Continuous Noncompliance with the Hospital Price Transparency Rule

We previously discussed the requirements of the Hospital Price Transparency Rule (“Rule”) on health care providers and health plans, as well as CMS’s proposal to increase penalties for a hospital’s failure to comply with the...more

6/20/2022 / Centers for Medicare & Medicaid Services (CMS) , Civil Monetary Penalty , Enforcement Actions , Health Care Providers , Healthcare , Hospitals , Noncompliance , Price Transparency

CMS Responds to Industry Stakeholder Feedback, Redesigns and Renames the GPDC Model for DCEs as the ACO REACH Model

On February 24, 2022, the Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), announced the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH)...more

3/9/2022 / ACOs , Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Fee-for-Service , Healthcare , Healthcare Reform , Medicare , REACH , Value-Based Care

CMS Corrects Inadvertent Omissions in Recent Stark Law Regulatory Amendments, Clarifies Reach of the Prohibition Related to...

Earlier this month, the Centers for Medicare and Medicaid Services (CMS) released its final rules for the 2022 Medicare Physician Fee Schedule (PFS Final Rule) and 2022 Medicare Hospital Outpatient Prospective Payment System...more

11/17/2021 / Centers for Medicare & Medicaid Services (CMS) , Compensation Agreements , Final Rules , Health Care Providers , Healthcare , Healthcare Reform , Medicare , New Regulations , Outpatient Prospective Payment System (OPPS) , Physician Fee Schedule , Physicians , Regulatory Agenda , Rulemaking Process , Self-Referral , Stark Law

Matthew Westbrook

Proskauer Rose LLP

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