Providers continually struggle to get the fair reimbursement they deserve from payers and often feel powerless to negotiate better rates. However, regulatory changes aimed at increasing price transparency and prohibiting gag...more
Ambulatory Surgery Centers (ASCs) are experiencing significant shifts in regulation, reimbursement, and operational practices. These changes are driven by evolving healthcare policies, technological advancements, and the...more
2/21/2025
/ Ambulatory Surgery Centers ,
Anti-Kickback Statute ,
Centers for Medicare & Medicaid Services (CMS) ,
Compliance ,
Department of Health and Human Services (HHS) ,
False Claims Act (FCA) ,
Healthcare Fraud ,
Medicaid ,
Medicare ,
OIG ,
Regulatory Reform ,
Regulatory Requirements ,
Revenue
Value-based care (VBC) is a healthcare delivery model that prioritizes patient outcomes over the volume of services provided. This approach aims to enhance the quality of care while controlling costs by incentivizing...more
1/24/2025
/ Alternative Payment Models (APM) ,
Centers for Medicare & Medicaid Services (CMS) ,
Compliance ,
Health Care Providers ,
Health Insurance ,
Healthcare Reform ,
Hospitals ,
Medicaid ,
Medicare ,
Physicians ,
Regulatory Requirements ,
Reimbursements ,
Value-Based Care ,
Value-Based Payments
On November 1, 2024, the Centers for Medicare & Medicaid Services (CMS) finalized the Medicare regulations interpreting the federal 60-day overpayment refund requirement (the Overpayment Statute) for Medicare Parts A and B as...more
12/18/2024
/ Centers for Medicare & Medicaid Services (CMS) ,
Compliance ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Good Faith ,
Health Care Providers ,
Investigations ,
Loper Bright Enterprises v Raimondo ,
Medical Reimbursement ,
Medicare ,
Overpayment ,
Physician Fee Schedule ,
Physicians ,
Recordkeeping Requirements ,
Reimbursements ,
Reporting Requirements
The IRS has recently been urging healthcare entities, particularly those involving physicians and private investors, to seek private letter rulings (PLRs) to clarify the tax implications of their ownership structures. This...more
11/13/2024
/ Anti-Kickback Statute ,
Compliance ,
Consolidated Tax Returns ,
Corporate Practice of Medicine ,
Health Care Providers ,
Healthcare Facilities ,
Intercompany Transactions ,
Internal Revenue Code (IRC) ,
IRS ,
Management Companies ,
Physicians ,
Private Letter Rulings ,
Professional Corporation
In 2024, Stark enforcement remains a critical focus for healthcare providers and regulatory bodies, with a continued focus on excessive compensation and productivity bonuses. Compliance with Stark Law is essential to avoid...more
11/1/2024
/ Centers for Medicare & Medicaid Services (CMS) ,
Compensation ,
Compliance ,
Department of Justice (DOJ) ,
Due Diligence ,
Health Care Providers ,
Loper Bright Enterprises v Raimondo ,
OIG ,
Patient Referrals ,
Physicians ,
Qui Tam ,
SEC v Jarkesy ,
Self-Disclosure Requirements ,
Social Security Act ,
Stark Law
The California Department of Public Health (CDPH) issued a letter on September 6, 2024, to all general acute care hospitals clarifying the scope of practice for Certified Registered Nurse Anesthetists (CRNAs) following...more
9/20/2024
/ Acute Facilities ,
California ,
CDPH ,
Documentation ,
Health Care Providers ,
Hospitals ,
Lack of Authority ,
Medicaid ,
Medical Billing Codes ,
Medicare ,
Nurse Practitioners ,
Physicians ,
Policies and Procedures ,
Reimbursements ,
Supervision
The American Academy of Emergency Medicine Physician Group (AAEM-PG) recently settled a lawsuit in United States District Court for the Northern District of California against Envision Healthcare and Envision Physician...more
8/2/2024
/ Anti-Kickback Statute ,
Corporate Practice of Medicine ,
Department of Health and Human Services (HHS) ,
Fair Market Value ,
Fee-Splitting ,
Fraud and Abuse ,
Healthcare ,
Healthcare Fraud ,
Medicaid ,
Medicare ,
Physician Ownership ,
Private Investment Funds
The Department of Health and Human Services (HHS), in conjunction with the Centers for Medicare and Medicaid Services (CMS), is striving to alleviate the financial strain of medication costs on the elderly and disabled...more
The Federal Trade Commission (FTC) issued a final rule to amend its Health Breach Notification Rule (HBN Rule). The HBN Rule requires certain entities that handle unsecured personally identifiable health data to notify...more
On May 21, the Centers for Medicare and Medicaid Services (CMS) announced a new option on CMS.gov to allow individuals to more easily file an Emergency Medical Treatment and Labor Act (EMTALA) complaint. Before launching the...more
5/29/2024
/ Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
EMTALA ,
Health Care Providers ,
Medical Examinations ,
Patients ,
Physicians ,
Policies and Procedures ,
Recordkeeping Requirements ,
Risk Management ,
SCOTUS
Centers for Medicare & Medicaid Service (CMS) revised hospital interpretive guidance in the State Operations Manual, Appendix A-Hospitals on April 1, 2024 in response to media stories of nation’s teaching hospitals and...more
Use of algorithms and artificial intelligence (AI) in prior authorization and utilization management is facing growing criticism and litigation. Notable lawsuits include alleged automatic authorization denials for tests that...more
3/1/2024
/ Algorithms ,
Artificial Intelligence ,
Bias ,
Centers for Medicare & Medicaid Services (CMS) ,
Denial of Insurance Coverage ,
Discrimination ,
Health Insurance ,
Healthcare ,
Innovative Technology ,
Life Sciences ,
Machine Learning ,
Medicaid ,
Medicare ,
Patient Access