News & Analysis as of

Department of Health and Human Services (HHS) Provider Payments

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

Foley & Lardner LLP

“Let’s Talk Compliance”: Medicare Advantage: Compliance Issues and Enforcement

Foley & Lardner LLP on

Editor’s Note: PYA and Foley & Lardner hosted the 6th Annual “Let’s Talk Compliance” two-day Virtual Conference on January 18 and 19, 2024. Panelists included Foley & Lardner attorneys and PYA experts. The event was hosted by...more

Jones Day

Medical Payment Products and Health Care Pricing Practices Draw CFPB Attention

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The Consumer Financial Protection Bureau (“CFPB”), Department of Health and Human Services (“HHS”), and United States Treasury have issued an interagency Request for Information (“RFI”) focused on the offering and provision...more

King & Spalding

Federal District Court Grants Injunction Barring CMS from Implementing New Policy on Medicaid Funding Designed to Prevent...

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On June 30, 2023, the United States District Court for the Eastern District of Texas (the Court) granted the State of Texas’ preliminary injunction motion, enjoining CMS from implementing and enforcing its Informational...more

Nelson Mullins Riley & Scarborough LLP

HHS Finalizes Payment Rates and Policies for the 2024 Medicare Advantage Program

On March 31, 2023, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), announced the finalized capitation rates and payment policies for the 2024 Medicare...more

Venable LLP

OIG Takes a Look at the Accelerated and Advance Payments Programs and the Provider Relief Fund Program

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The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) recently conducted two audits of HHS management of healthcare provider loan and funding programs during the COVID-19 pandemic. Two...more

Foley & Lardner LLP

OIG Issues Report Suggesting Medicare Advantage Companies Perform Chart Reviews and Health Risk Assessments to Drive Higher...

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On September 20, 2021 the Office of the Inspector General of the U.S. Department of Health and Human Services (OIG) issued a report suggesting that certain Medicare Advantage (MA) companies were leveraging chart reviews and...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

Foley & Lardner LLP

Let’s Talk Compliance Recap: Provider Relief Fund Reporting Requirements & Compliance Concerns

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In the latest installment of our “Let’s Talk Compliance” series, Foley & Lardner’s Alexis Bortniker and PYA’s Martie Ross answered numerous questions regarding Provider Relief Fund (PRF) reporting requirements. A recording of...more

Mitchell, Williams, Selig, Gates & Woodyard,...

"No Surprises Act" Compliance Tips For Group Health Plans and Health Insurance Issuers

On July 13th, group health plans and health insurance issuers subject to the Federal No Surprises Act (the “Act”) received the first phase of interim final rules promulgated under the Act (the “Rules”) and issued by the...more

Bass, Berry & Sims PLC

HHS Changes Course: Requires Repayment of Excess Relief Funds Received

Bass, Berry & Sims PLC on

On December 4, the U.S. Department of Health and Human Services (HHS) revised its Public Health and Social Services Emergency Fund (Relief Fund) Frequently Asked Questions (FAQs), indicating that providers must return Relief...more

Sheppard Mullin Richter & Hampton LLP

More Relief on the Way for Healthcare Providers: Provider Relief Fund Payment Opportunities and Flexibility in Repayment...

As the pandemic rages on, and the United States has seen a spike in coronavirus cases in recent days, many healthcare providers are still struggling to care for patients and remain afloat. In response, HHS is continuing...more

Roetzel & Andress

HHS’ FAQs Address Restrictions On The Transfer Of Provider Relief Fund Payments In Healthcare Transactions

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Purchasers and sellers of healthcare entities that received or intend to apply for Provider Relief Fund payments need to be aware of the restrictions on the receipt and transfer of those payments. By way of background,...more

Jackson Walker

HHS Issues Medicaid/CHIP Provider Relief Fund Payment Forms and Guidance

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The U.S. Department of Health & Human Services (HHS) expects to distribute $15 billion to eligible Medicaid and CHIP providers. The payment to each provider will be at least 2% of reported gross revenue from patient care; the...more

Roetzel & Andress

Update To Provider Relief Payment Reporting Requirements

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As detailed in our prior Alerts, persons receiving “Provider Relief Funds” in excess of $150,000 through the Coronavirus Aid, Relief, and Economic Security (CARES) Act (Cares Act) were required to submit quarterly reports to...more

Fox Rothschild LLP

HHS Announces Relief Fund Payments For Medicaid & CHIP Providers, Safety Net Hospitals And Enhanced Provider Relief Fund Portal

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In a Press Release issued Tuesday afternoon, the U.S. Department of Health and Human Services (HHS) announced they will distribute approximately $15 billion to eligible providers that participate in state Medicaid and...more

Roetzel & Andress

Recent HHS Provider Relief Payment Updates

Roetzel & Andress on

Since our May 11, 2020 Alert “HHS Provider Payment Updates,” the Department of Health and Human Services (HHS) has issued additional guidance through updated FAQs for payments health care providers received pursuant to phases...more

Husch Blackwell LLP

CARES Act Provider Relief Fund: Connecting HHS's Dots On Whether Your Tranche #1 Payment Is An Overpayment

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After the U.S. Department of Health and Human Services (HHS) automatically distributed $30 billion to providers as Tranche #1 Relief Fund payments based on 2019 Medicare fee-for-service payment data, HHS subsequently released...more

Roetzel & Andress

HHS Provider Payments Update

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As detailed in our April 29, 2020 Alert “HHS Provider Payments: Lack of Clarity Means Risk of Retention,” many health care providers received payments pursuant to the Coronavirus Aid, Relief, and Economic Security (CARES)...more

Health Care Compliance Association (HCCA)

Payment Dispute Triggered First 2020 OCR Settlement

Report on Patient Privacy 20, no. 3 (March 2020) - A gastroenterologist in Utah who felt he was being held captive by an electronic health record (EHR) vendor found his 2013 complaint to the HHS Office for Civil Rights...more

McDermott Will & Emery

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

McDermott Will & Emery on

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

Health Care Compliance Association (HCCA)

Report on Medicare Compliance Volume 29, Number 7. News Briefs: February 2020 #4

Report on Medicare Compliance 29, no. 7 (February 24, 2020) -  Guardian Elder Care Holdings Inc., which operates more than 50 skilled nursing facilities (SNFs) in Pennsylvania, Ohio and West Virginia, and its related...more

K&L Gates LLP

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

K&L Gates LLP on

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

Health Care Compliance Association (HCCA)

Report on Medicare Compliance Volume 28, Number 44. News Briefs: December 2019

Report on Medicare Compliance 28, no. 44 (December 16, 2019) - ? Korunda Medical LLC, a Florida-based company that provides primary care and interventional pain management, has agreed to pay $85,000 to settle a potential...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

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