Michael Cassidy at Tucker Arensberg, P.C.

2025 Medicare Final Rule Highlights

CMS issued its Final Rule for the 2025 Medicare Physician Fee Schedule in November. Originally published in the Allegheny County Medical Society (ACMS) Bulletin - December 2024....more

1/13/2025 / Centers for Medicare & Medicaid Services (CMS) , Final Rules , Health Care Providers , Health Insurance , Healthcare , Healthcare Reform , Medicare , Medicare Advantage , Physician Fee Schedule , Physicians

Federal and Pennsylvania Corporate Reporting Requirements: Subject to Nationwide Injunction

This is a last in a series of client alerts and blog posts we’ve issued over the last year designed to inform you of the new Federal and Pennsylvania corporate reporting obligations....more

12/5/2024 / Beneficial Owner , Business Entities , Corporate Governance , Corporate Transparency Act , Corporations Code , FinCEN , Preliminary Injunctions , Regulatory Requirements , Reporting Requirements

Medicare Telehealth Reimbursement Update

Our Introduction to Telehealth, Technology and Federal Enforcement chapter was published in the Thomson Reuters 2025 Health Law Handbook. It reviewed a number of telehealth Medicare revisions, both permanent and temporary,...more

11/21/2024 / Coronavirus/COVID-19 , Medicare , Physician Fee Schedule , Proposed Legislation , Telehealth , Telemedicine

Medicare Decreases Physician Fee Schedule by 2.93%

The final Medicare Physician Fee Schedule was issued on November 1st for calendar year 2025. Attached is a link to both the Press Release describing all of the Medicare changes and the link to the entire Final Rule....more

11/12/2024 / Centers for Medicare & Medicaid Services (CMS) , Final Rules , Health Care Providers , Medicare , Physician Fee Schedule , Physician Medicare Reimbursements , Physicians

Medicare Proposes 2.8% Physician Fee Schedule Reduction

See below for the CMS (Centers for Medicare & Medicaid Services) Announcement on July 10, 2024 proposing a reduction in the Medicare Conversion Factor payment from $33.29 to $32.36, i.e. 2.8%...more

7/15/2024 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicare , Physician Fee Schedule , Physicians , Proposed Rules

Medicare Proposed 2025 Telehealth Changes

CMS proposed several telehealth changes in the 2025 Medicare Physician Fee Schedule Proposed Rule, issued July 10, 2024....more

7/15/2024 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicare , Physician Fee Schedule , Proposed Amendments , Telehealth , Telemedicine

UPMC/Washington Health System Merger Agreement Limits Non-Competes

The Press has announced that the Merger Agreement between UPMC and Washington Health System was approved by the Pennsylvania Attorney General with certain conditions, one of which was that UPMC would honor existing employment...more

6/5/2024 / Employment Contract , Mergers , Non-Compete Agreements , Restrictive Covenants , State Health Plans

PA House Passes Physician Non-Compete Limitations

The Allegheny County Medical Society has reported that the Pennsylvania House of Representatives has passed a bill to bar non-compete agreements in healthcare employment....more

4/18/2024 / Health Care Providers , Healthcare Facilities , Hospitals , Non-Compete Agreements , Pending Legislation , Physicians

Medicare Conversion Factor Increased to $33.2875

The 2024 Consolidated Appropriations Act passed and signed on Saturday, March 23, 2024, increased of Medicare Conversion Factor from $32.7442 to $33.2875, an increase of slightly over $0.54....more

3/28/2024 / Consolidated Appropriations Act (CAA) , Medicare

U.S. Department of Justice (DOJ) Provides Corporate Fraud Enforcement Update

During the American Bar Association’s 39th National Institute on White Collar Crime, the most senior executives of the DOJ (Attorney General Merrick B. Garland and Deputy Attorney General Lisa Monaco) delivered remarks...more

3/18/2024 / Compliance , Cooperation , Corporate Crimes , Corporate Misconduct , Department of Justice (DOJ) , Enforcement Priorities , Voluntary Disclosure , White Collar Crimes

HHS Healthcare Sector Cybersecurity

The healthcare sector is particularly vulnerable to cybersecurity risks and the stakes for patient care and safety are particularly high. Healthcare facilities are attractive targets for cyber criminals in light of their...more

1/16/2024 / Biden Administration , Cyber Attacks , Cyber Incident Reporting , Cybersecurity , Data Breach , Department of Health and Human Services (HHS) , Health Care Providers , Healthcare Facilities , OCR , Popular , Ransomware

False Claims Act (FCA) Liability for Physician Compensation Exceeding Fair Market Value (FMV)

When negotiating physician compensation issues, hospitals frequently rely upon the premise they must pay fair market value compensation in order to comply with the provisions of the Stark Act prohibiting referrals in exchange...more

1/3/2024 / Department of Justice (DOJ) , Employment Contract , Enforcement Actions , Fair Market Value , False Claims Act (FCA) , Hospitals , Physicians , Referral Fees , Stark Law

2024 Medicare Physician Fee Schedule - Update

CMS issued the Final Rule for the 2024 Medicare Physician Fee Schedule (PFS) on November 2, 2023, for payments to be effective on or after January 1, 2024. Fee Schedule Link The overall payment rates under the PFS will be...more

11/6/2023 / Centers for Medicare & Medicaid Services (CMS) , Final Rules , Medicare , Physician Fee Schedule , Physicians

Biden Administration to Appeal Surprise Billing Defeat

As reported earlier in the MedLaw Blog (August 9, 2023), a federal District Court vacated portions of the No Surprises Act federal regulations. Thereafter, CMS halted the arbitration process for resolving disputes regarding...more

10/25/2023 / Arbitration , Biden Administration , Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , No Surprises Act (NSA) , OPM , Out of Network Provider , Surprise Medical Bills , U.S. Treasury

CMS Halts “No Surprises Act” Arbitration

CMS has halted the arbitration process for “Surprise Billing” established by the “No Surprises Act” for the second time, stating as follows...more

8/10/2023 / Arbitration , Centers for Medicare & Medicaid Services (CMS) , Dispute Resolution , Health Care Providers , No Surprises Act (NSA) , Out of Network Provider , Surprise Medical Bills

2024 Medicare Physician Fee Schedule

The 2024 Medicare Physician Fee Schedule proposes a 3.34% decrease in the 2024 PFS conversion factor. It’s currently $33.89 and is proposed to be reduced to $32.75....more

7/17/2023 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicare , Physician Fee Schedule , Physicians

Private Equity: Investigation and Enforcement

Since the private equity issue was last addressed in the Bulletin in the Summer of 2022, the volume of healthcare private equity deals has subsided somewhat, according to statistics presented at the March 2023 Pennsylvania...more

5/1/2023 / Acquisitions , Centers for Medicare & Medicaid Services (CMS) , Congressional Investigations & Hearings , Corporate Practice of Medicine , Health Care Providers , Hospitals , Investment , Investors , Motor Vehicle Safety Whistleblower Program (MVSWP) , Private Equity , Private Equity Firms

FTC Proposes a Rule to Prohibit Non-Compete Agreements

On January 5, 2023, the Federal Trade Commission (FTC) took a dramatic step by proposing a new rule that would prohibit companies from entering into non-compete agreements with its workers. The proposed rule, if approved,...more

2/3/2023 / Employment Contract , Federal Trade Commission (FTC) , Health Care Providers , Independent Contractors , Non-Compete Agreements , Nonprofits , Physicians , Proposed Rules , Public Comment , Restrictive Covenants , Unfair Competition

Medicare Physician Fee Schedule Reductions Partially Offset

The final “2023 Omnibus Bill” which is the spending bill passed by Congress and signed by President Biden at the end of 2022, provides partial relief from the scheduled Medicare Physician Fee Schedule Conversion Factor cuts. ...more

1/11/2023 / Health Care Providers , Medicare , Physician Fee Schedule , Physicians

Reforming Prior Authorization Process: Federal and Pennsylvania

Both the federal government and the Pennsylvania state government are taking steps to reform the prior authorization process. Attached is the Pennsylvania Insurance Department Press Release, issued November 3, 2022, touting...more

12/12/2022 / Centers for Medicare & Medicaid Services (CMS) , Comment Period , Department of Insurance , Health Insurance , New Legislation , Prior Authorization

Telemedicine Special Fraud Alert

The US Office of Inspector General (OIG) released another in a series of Special Fraud Alerts on July 20, 2022, this one directed to potentially fraudulent telehealth, telemedicine, and telemarketing service fraud schemes,...more

7/22/2022 / Fraud , Fraud Alerts , Health Care Providers , Kickbacks , OIG , Physicians , Telehealth , Telemarketing , Telemedicine

Medicare Proposes 2023 Physician Pay Cuts

On July 7, 2022, CMS released its proposed Medicare Physician Fee Schedule for 2023, which proposes physician fee schedule reductions via the Medicare Conversion Factor. ...more

7/22/2022 / Centers for Medicare & Medicaid Services (CMS) , Medicare , Physician Fee Schedule , Physicians

2022 Budget Bill Includes Mandatory Healthcare Cyber Incident Reporting

The Cyber Incident Reporting for Critical Infrastructure Act (CIRCIA), was passed as part of the consolidated Budget Act for 2022, which also included the telehealth provisions. The definition of “covered entity” in the...more

4/5/2022 / Covered Entities , Cyber Attacks , Cyber Incident Reporting , Cybersecurity Information Sharing Act (CISA) , Department of Homeland Security (DHS) , Federal Budget , Health Care Providers , Health Insurance Portability and Accountability Act (HIPAA) , Medicare

HHS Requesting Physician COVID Relief Payback of $100 Million

HHS sent notices to noncompliant physicians and facilities on March 10, 2022 giving them 30 days to return funds paid to healthcare providers who have not complied with the agency’s reporting requirements....more

3/31/2022 / Compliance , Coronavirus/COVID-19 , Department of Health and Human Services (HHS) , Federal Grants , Health Care Providers , HRSA , Physicians , Reporting Requirements

Congress Extends Telehealth Coverage

The President and Congress extended Medicare telehealth coverage in the Consolidated Appropriations Act, which also included additional Ukrainian relief. On Tuesday, March 15, 2022, President Biden signed the Consolidated...more

3/21/2022 / Centers for Medicare & Medicaid Services (CMS) , Consolidated Appropriations Act (CAA) , Health Care Providers , Medicare , Physicians , Telehealth , Telemedicine , Time Extensions

Michael Cassidy

Tucker Arensberg, P.C.

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