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Department of Health and Human Services (HHS) Medicare Medicare Part A

Health Care Compliance Association (HCCA)

Privacy Briefs: September 2024

The HHS Centers for Medicare & Medicaid Services (CMS) and Wisconsin Physicians Service Insurance Corporation (WPS) are notifying 946,801 people whose protected health information or other personally identifiable information...more

McCarter & English, LLP

Payment Flexibilities and New Legislation Introduced Regarding Healthcare Cyberattacks

For the past month or longer, many providers have reported a significant impact on their revenue cycle due to the cyberattack on Change Healthcare, LLC. In light of that impact, the Centers for Medicare & Medicaid Services...more

McDermott+

President Biden Releases FY 2025 Budget: What’s NOT in It?

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Earlier this week, President Biden released his Fiscal Year (FY) 2025 President’s Budget. As a reminder, every year, the White House releases a budget that serves as its official funding request to Congress for the following...more

Holland & Knight LLP

Holland & Knight Health Dose: October 17, 2023

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Holland & Knight Health Dose is an in-depth weekly dose of legislative and regulatory insights to keep stakeholders abreast of happenings in Washington, D.C., impacting the health sector. ...more

King & Spalding

D.C. Circuit Holds that Those “Entitled to Supplemental Security Income Benefits” Means Receiving Cash Payment for Hospital DSH...

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Last week, the D.C. Circuit held that Medicare beneficiaries “entitled to supplemental security income [(SSI)] benefits under Title XVI of the Social Security Act” means only those patients receiving cash payments for...more

Bass, Berry & Sims PLC

CMS Proposed Rule Addresses Multiple Aspects of Medicare Advantage Program for 2024, Including an Overpayment Rule Update

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On December 14, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that contemplates several changes to, and clarifications of, guidance for the Medicare Advantage (MA) program in coverage year 2024....more

Miles & Stockbridge P.C.

In Becerra v. Empire Health Foundation, the Supreme Court Reaffirmed Reduced Disproportionate Share Hospital Payments

On June 24, 2022, the U.S. Supreme Court decided Becerra v. Empire Health Foundation and resolved a split between the U.S. Courts of Appeal for the 6th, 9th and District of Columbia Circuits in favor of how the Department of...more

Holland & Knight LLP

Supreme Court Backs Rule That Decreases Medicare Payments to Safety-Net Hospitals

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The U.S. Supreme Court settled an Administrative Procedures Act (APA) dispute on June 24, 2022, involving Medicare's formula to adjust rates paid to safety-net hospitals, clarifying a statute that dictates how to calculate...more

Faegre Drinker Biddle & Reath LLP

Supreme Court Decides Becerra v. Empire Health Foundation

On June 24, 2022, the U.S. Supreme Court decided Becerra v. Empire Health Foundation, No. 20-1312, holding that, in calculating the “Medicare fraction” component in determining Medicare reimbursements to hospitals,...more

Health Care Compliance Association (HCCA)

Hooper, Kearney and Macklin on Cutting Edge Topics in the False Claims Act

While the pandemic put many things on hold, it did not do the same for the False Claims Act (FCA). To find out what is happening in FCA activity we spoke with Patrick Hooper, Jordan Kearney and Alicia Macklin, partners at the...more

Mintz - Health Care Viewpoints

Telehealth Update:  New Bill Seeks to Understand the Impact of Telehealth During COVID-19 as State COVID-19 Orders Expire

As previously discussed, many of the telehealth flexibilities in place during the COVID-19 pandemic are set to expire at the end of the federal Public Health Emergency (PHE), unless federal and state legislators act to make...more

Dorsey & Whitney LLP

The Supreme Court - July 2, 2021

Dorsey & Whitney LLP on

Hughes v. Northwestern University, No. 19-1401: Whether allegations that a defined-contribution retirement plan paid or charged its participants fees that substantially exceeded fees for alternative available investment...more

Health Care Compliance Association (HCCA)

Report on Medicare Compliance Volume 30, Number 8. News Briefs: March 2021

Report on Medicare Compliance 30, no. 8 (March 1, 2021) - According to a CMS spokesperson, “CMS has not yet determined when Targeted Probe and Educate reviews will resume.” Meanwhile, “CMS continues to temporarily pause...more

McGuireWoods LLP

Omnibus Appropriations Package Includes Changes for Medicare and Medicaid Beneficiaries

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Passed by Congress Dec. 21, 2020, and signed by President Donald Trump Dec. 27, 2020, the $1.4 trillion omnibus Consolidated Appropriations Act includes numerous provisions that directly impact Medicare and Medicaid...more

McGuireWoods Consulting

Washington Healthcare Update - November 2020 #1

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This week in Washington: Washington’s focus has been on the presidential and Senate races....more

King & Spalding

HHS Expands Eligibility for Provider Relief Fund Phase 2 General Distribution

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Last week, HHS announced that it will now accept additional applicants for the Provider Relief Fund Phase 2 General Distribution. All eligible providers will only receive funding of up to 2 percent of their reported total...more

Chambliss, Bahner & Stophel, P.C.

Provider Relief Fund Phase 2 Eligibility: Clarifications and Further Questions

As explained in our prior alert, the Department of Health and Human Services (HHS) is offering certain Medicare providers an additional opportunity to apply—by August 28, 2020—for Provider Relief Fund (PRF) distributions from...more

McDermott Will & Emery

CMS Releases Fact Sheets on COVID-19 Medicare Coverage, Billing Guidelines

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The Centers for Medicare and Medicaid Services (CMS) released several fact sheets on COVID-19 coverage and benefits, and announced a second Healthcare Common Procedure Coding System (HCPCS) code, U0002, for billing COVID-19...more

K&L Gates LLP

K&L Gates Triage: The Impact of Allina — Potential Limitation on CMS’s Ability to Recoup Overpayments

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In this week’s episode, Adam Cooper discusses the Supreme Court’s decision in Azar v. Allina Health Services, as well as a related memorandum issued in late 2019 by the Centers for Medicare and Medicaid Services (“CMS”) that...more

Morgan Lewis - Health Law Scan

HHS Analyzes Legal Impact of Allina on Agency Enforcement

The US Department of Health and Human Services (HHS) Office of General Counsel (OGC) offered the healthcare industry the benefit of its legal analysis of the recent US Supreme Court opinion in Azar v. Allina Health Services...more

Polsinelli

CMS Outlines New Standard for Challenging Medicare Payment Denials, Echoing Brand Memo on Force of Sub-Regulatory Guidance

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On October 31, 2019, the Office of General Counsel for the U.S. Department of Health and Human Services (HHS) issued an important memo from Kelly M. Cleary, CMS Chief Legal Officer, and Brenna E. Jenny, Deputy General...more

Bricker Graydon LLP

Recent OIG audit report on duplicate Medicare payments for drugs prescribed to hospice patients shows tension between OIG and CMS...

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On August 22, 2019, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) issued a report following up to an audit that the OIG performed in 2012 indicating that Medicare Part D paid for...more

King & Spalding

How Payers Are Improperly Underpaying Inpatient Services As Observation Services

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Health plans and their delegated IPAs are using a number of different tactics to deny payment for inpatient services by improperly classifying inpatient claims as observation or other types of outpatient status. Payers are...more

Polsinelli

Azar v. Allina Health Services: Hospitals Claim (Procedural) Victory in DSH Dispute

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On June 3, 2019, the Supreme Court issued an eagerly anticipated opinion in Azar v. Allina Health Services, a decision with far-reaching implications both for the calculation of disproportionate share payments and provider...more

Brownstein Hyatt Farber Schreck

Medicare Rulemaking After Azar v. Allina Health Services

The Medicare Program, established in 1965, initially seemed simple: provide health care for senior citizens by paying hospitals and doctors directly for the care the seniors required. Initially, there were two parts to...more

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