News & Analysis as of

Healthcare Medicare Compliance

Ankura

OIG Testimony Puts a Spotlight on Clinical Documentation and Payer Risk

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In recent testimony before the United States House Committee on Energy and Commerce Subcommittee on Oversight and Investigations, Christi A. Grimm, Inspector General of the Department of Health and Human Services (HHS)...more

NAVEX

Healthcare Organizations are Facing Increased Scrutiny – Here's What You Need to Know

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2024 is shaping up to be a very active year for regulatory and enforcement developments in the healthcare industry – developments that concern not just hospitals and nursing facilities, but many non-healthcare companies as...more

McNees Wallace & Nurick LLC

The OIG Releases Updated General Compliance Program Guidance

As 2023 came to a close, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) released an updated General Compliance Program Guidance (GCPG) manual, which serves as a reference guide for...more

Health Care Compliance Association (HCCA)

News Briefs: September 11, 2023

The HHS Office for Civil Rights (OCR) on Sept. 7 announced a proposed rule to bar discrimination based on disability.[1] “The rule, Nondiscrimination on the Basis of Disability in Programs or Activities Receiving Federal...more

McDermott Will & Emery

Private Investors and Digital Health Attracting OIG Attention: General Compliance Program Guidance to Watch

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On November 6, 2023, the US Department of Health and Human Services (HHS) Office of Inspector General (OIG) published the General Compliance Program Guidance (GCPG) as a revised reference guide for the healthcare compliance...more

Butler Snow LLP

Health Care Due Diligence: An Ounce of Prevention is Worth a Pound of Cure

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Due diligence properly performed in connection with the purchase and sale of a health care entity is simply different—vastly so—than due diligence performed in other contexts. Failure to recognize this reality can lead to...more

Health Care Compliance Association (HCCA)

News Briefs: July 2023

Report on Medicare Compliance Volume 32, no 25 (July 2023) Hospices in four states will face heightened oversight. “CMS is placing newly enrolling hospices located in Arizona, California, Nevada, and Texas in a provisional...more

Health Care Compliance Association (HCCA)

Adding some spice to your compliance program

Every quarter, each acute care hospital that is paid under the Inpatient Prospective Payment System has access to an Excel workbook that contains valuable information about your hospital’s compliance with myriad Medicare...more

J.S. Held

AHLA Takeaway: Healthcare Executives, Is Your House In Order?

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Walking away from the American Health Law Association’s annual conference, I’m feeling energized from (re)connecting with friends and colleagues, inspired by the complex and transformational work being done throughout the...more

Health Care Compliance Association (HCCA)

Enforcement actions relating to a lack of medical necessity

In a climate of shrinking margins, diminishing reimbursement, and frequent denials, healthcare organizations may make efforts to increase the volume of services they provide, especially those that are more profitable. Of...more

Foley & Lardner LLP

Key Takeaways from the Foley/PYA “Let’s Talk Compliance” 2-Day Virtual Conference

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Session #1: State of the Healthcare Industry Effective Compliance Plans and Enforcement Trends - In their discussion of compliance program effectiveness and enforcement, attorneys Kolarik and Waltz and Ms. Sumner...more

Ankura

Behind the Expert: Applying a Proactive Approach to Healthcare Compliance with Nancy Waltermire

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"Rather than reacting, you must be proactive and preventive. By doing this, you will not only be prepared for the potential obstacles that face your company, but you will most likely eliminate obstacles before they appear." ...more

Stoel Rives - Health Law Insider®

CMS Issues Final Rule Authorizing Extrapolation as Part of RADV Audits

As a result of a new rule published on February 1, 2023, at 88 Fed. Reg. 6643, Medicare Advantage (MA) organizations soon will be facing enhanced exposure from Risk Adjustment Data Validation (RADV) audits. Under the new...more

Harris Beach PLLC

Continued: Summary of Fraud and Abuse Enforcement Yields Insight for Health Care Compliance and Risk Assessment

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The following is a summary of the federal Health and Human Services agency’s Office of Inspector General (OIG) reports of fraud and abuse enforcement activity across the country. The enforcement actions reported are based...more

Foley & Lardner LLP

Compliance Issues in Hospital and Health System Sports Sponsorships

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Many hospital, health systems and other health care providers have seen benefits in sponsoring sports teams, stadiums and athletic tournaments. Considerations include general branding in the community, recruitment of staff or...more

Seyfarth Shaw LLP

Seyfarth Policy Matters Newsletter - April 2020 #3

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Congress Replenishes Paycheck Protection Program (PPP) Through its Phase Four Coronavirus Relief Package. On Tuesday, via unanimous consent, the Senate passed the Paycheck Protection Program Increase Act of 2020...more

Seyfarth Shaw LLP

Senate Passes Another Round of Coronavirus Relief to Replenish the Paycheck Protection Loan Program and Other Programs;...

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Summary - Late yesterday, the Senate passed the Paycheck Protection Program Increase Act of 2020. The measure appropriates a total of $484 billion, mainly to refund the Paycheck Protection Program (PPP), but also to provide...more

Chambliss, Bahner & Stophel, P.C.

CARES Financial Relief for Health Care Providers

The CARES Act adds $100 billion to the “Public Health and Social Services Emergency Fund” to reimburse “eligible health care providers” for “health care-related expenses or lost revenues that are attributable to Coronavirus.”...more

Chambliss, Bahner & Stophel, P.C.

CARES Relief for State and Local Governments

The CARES Act establishes a $500 billion loan program accessible by cities, states, and businesses, while also providing for more than $250 billion in direct funding to state and local governments. The majority of the direct...more

ArentFox Schiff

IRS Clarifies Interaction of Payroll Tax Deferral with PPP Loan Forgiveness Under CARES Act

ArentFox Schiff on

On April 10, the Internal Revenue Service published responses to frequently asked questions with respect to the payroll tax deferral provisions of the CARES Act, including clarification that employers that take loans under...more

Snell & Wilmer

CARES Act Appropriates $100 Billion for Healthcare Providers

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With the passage of the CARES Act, $100 billion has been appropriated to the Public Health and Social Services Emergency Fund (“PHSSEF”), to be administered by a small agency within the Department of Health and Human Services...more

Sheppard Mullin Richter & Hampton LLP

Answers for Nonprofits Seeking Relief under the CARES Act

In this time of crisis, nonprofits of all shapes and sizes have been scrambling to obtain assistance under the federal CARES Act. Sheppard Mullin’s Nonprofit Team is grateful for the special opportunity to help by partnering...more

King & Spalding

False Claims Act Considerations Related to the CARES Act's Small Business Administration Loan Program

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On March 27, 2020, Congress passed the Coronavirus Aid, Relief and Economic Security (CARES) Act, which authorized $2.2 trillion to, among other things, help companies and individuals mitigate the financial repercussions...more

Harris Beach PLLC

New York Budget Bill Includes Changes in Employee Leave Law

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It might not be business as usual, but business in New York goes on even as the state grapples with the coronavirus pandemic. New York State’s annual budget bill, signed by Gov. Cuomo on April 3, contains amendments to New...more

Harris Beach PLLC

Summary of Key Tax Provisions for Businesses Under CARES Act

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The following is a summary of certain key tax provisions relevant to businesses outlined in the Coronavirus Aid, Relief, and Economic Security Act (“CARES Act"-- H.R. 748). The CARES Act provides financial support to...more

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