Teresa Mason on Medicare

Medicare Advantage, Part D, and More: Proposed Rule Outlines Significant Policy and Technical Changes for CY 2025

On November 15, 2023, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule titled Contract Year 2025 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit...more

12/13/2023 / Centers for Medicare & Medicaid Services (CMS) , Comment Period , Drug Pricing , Health Insurance , Health Plan Sponsors , Medicare , Medicare Advantage , Medicare Part D , Out-of-Pocket Expenses , Pharmaceutical Industry , Prescription Drugs , Proposed Rules

CMS’s Final Rule on Medicare Advantage Risk Adjustment Data Validation

On February 1, 2023, the Centers for Medicare & Medicaid Services (CMS) published a final rule outlining its audit methodology and related policies for its Medicare Advantage (MA) Risk Adjustment Data Validation (RADV)...more

2/3/2023 / Centers for Medicare & Medicaid Services (CMS) , Final Rules , Medicare , Medicare Advantage , Medicare Advantage Organizations (MAOs)

Biden Administration Prioritizes Health Equity in Proposed Reforms to Medicare Managed Care

The Centers for Medicare & Medicaid Services (CMS) recently issued the Medicare Advantage (MA) and Part D proposed rule for contract year 2024 (the “Proposed Rule”), which represents the Biden administration’s broadest effort...more

1/24/2023 / Biden Administration , Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Healthcare , Hospitals , Medicare , Physicians

In Wake of Dobbs Decision, CMS Issues Guidance to Hospitals on EMTALA Obligations

Last week, the Centers for Medicare & Medicaid (CMS) issued guidance to remind hospitals of their ongoing federal obligations under the Emergency Medical Treatment and Labor Act (EMTALA), specifically when treating patients...more

7/25/2022 / Abortion , Centers for Medicare & Medicaid Services (CMS) , Dobbs v. Jackson Women’s Health Organization , Health Care Providers , Hospitals , Medicaid , Medicare , Physicians , Pregnancy , Texas

CMS Wins on Partial Appeal—D.C. Circuit Court Rules Against United’s Initially Successful Challenge to the Medicare Part C...

On August 13, 2021, the U.S. Court of Appeals for the District of Columbia Circuit (“D.C. Circuit”), in a much-anticipated decision, unanimously reversed rulings by the U.S. District Court for the District of Columbia...more

8/24/2021 / Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Health Care Providers , Healthcare , Medicaid , Medicare , Overpayment , Overpayment Recovery Time Limits

OIG Audits on Medicare Advantage Plans Continue

On April 19, 2021, the Office of Inspector General’s (OIG) Office of Audit Services (OAS) released the results of an audit conducted on the accuracy of diagnosis codes submitted to CMS by Humana, Inc. for 2015 dates of...more

4/27/2021 / Audits , Centers for Medicare & Medicaid Services (CMS) , Medicare , Medicare Advantage , OIG

HHS-OIG Work Plan – Medicare Advantage

Providers, plans, and vendors that provide services under the Medicare Advantage program, should be aware that the Office of Inspector General (“OIG”) of the U.S. Department of Health and Human Services (“HHS”) is once again...more

9/25/2018 / Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , False Claims Act (FCA) , Hospitals , Managed Care Contracts , Medicare , Medicare Advantage , Medicare Part A , Medicare Part B , OIG , Physicians , Work Plans

Teresa Mason

Epstein Becker & Green

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