On August 11, 2021, United Healthcare and its affiliates were served with separate enforcement lawsuits by the Department of Labor (DOL) and the New York Attorney General (NY AG) involving mental health parity, among other...more
We previously blogged about the new Mental Health Parity and Addiction Equity Act (MHPAEA) reporting and disclosure requirements established by the Consolidated Appropriation Act, 2021 (CAA). As a refresher, employers...more
Report on Medicare Compliance Volume 29, no. 32 (September 14, 2020) - In an audit of 100 outlier payments, the HHS Office of Inspector General (OIG) said Baylor Scott & White – College Station, a hospital in Texas, didn’t...more
The OIG added six new items to its Work Plan in the July 2018 update. Areas addressed include HHS cybersecurity vulnerabilities, increased payments for transfer claims with outliers, oversight of funds for Access Increases in...more
On November 3rd, CMS published the Final Prospective Payment System (PPS) Rule for Home Health Agencies (HHAs) for CY 2017 at 81 FR 76702 (Nov. 3, 2016). The rule implements annual changes to the PPS rate for HHAs and...more
In Banner Heart Hospital, et al. v. Burwell, the United States District Court for the District of Columbia (Court) held on August 19, 2016, that the Provider Reimbursement Review Board (PRRB) incorrectly declined to hear an...more
On August 19, 2016, the United States District Court for the District of Columbia granted a group of hospitals’ motion for summary judgment against HHS in a challenge of the Provider Reimbursement Review Board’s (PRRB) denial...more
The US Department of Health and Human Services (HHS) Centers for Medicare & Medicaid Services (CMS) released proposed updates to its Calendar Year (CY) 2017 Home Health Prospective Payment System (HH PPS) in the July 5, 2016,...more
On March 31, 2016, Judge Colleen Kollar-Kotelly of the United States District Court for the District of Columbia (the “D.C. District Court”) issued a highly anticipated memorandum opinion settling what will probably be the...more
On January 22, 2016, CMS published an explanation of its FY 2004 outlier fixed-loss threshold rulemaking. The explanation was required by two 2015 federal court orders in cases brought by hospitals challenging the outlier...more
In a decision issued May 19, 2015, the United States Court of Appeals for District of Columbia Circuit handed hospitals a partial victory in their challenge to their Medicare outlier payments for 2004. District Hospital...more
The D.C. Circuit Court of Appeals recently issued a partially favorable ruling for hospitals seeking additional outlier payments under the Medicare program. In District Hospital Partners v. Burwell, a three-judge panel held...more
In a recent report [PDF], the Department of Health and Human Services Office of the Inspector General (OIG) highlighted hospital outlier payment trends it found troubling: Of the nearly 3,200 hospitals reviewed, approximately...more