To offset the cost of other provisions in the bill, the One Big Beautiful Bill Act (OBBBA) includes significant reforms to Medicaid, Medicare, and Affordable Care Act (ACA) premium tax credits that are expected to result in...more
On September 30, 2024, a federal district court in Florida held the qui tam enforcement provision of the False Claims Act (“FCA”), which permits private citizens to pursue actions in the name of and on behalf of the...more
10/11/2024
/ Appointments Clause ,
Article II ,
False Claims Act (FCA) ,
Federal Rules of Civil Procedure ,
Florida ,
Medicare ,
Officers of the United States ,
Qui Tam ,
Relators ,
SCOTUS ,
Take Care Clause ,
United States ex rel Polansky v Executive Health Resources Inc
On March 28, 2023, the Sixth Circuit issued a decision interpreting the definition of remuneration under the Anti-Kickback Statute (AKS) and the level of causation necessary for a False Claims Act (FCA) action to be premised...more
On October 21, 2022, CMS announced new actions to increase accountability and scrutiny on nursing homes in the Special Focus Facilities Program (SFF Program), an oversight program for the poorest performing nursing homes in...more
On May 2, 2022, OIG posted Advisory Opinion 22-10, regarding a proposal to provide financial assistance and free items to individuals with a particular disease. The Requestor, a non-profit organization dedicated to providing...more
Last week, OIG released a report analyzing trends in the last decade relating to Medicare payments for hospice beneficiaries outside of the hospice per diem. In the report, OIG notes that CMS has taken the position that...more
Last week, HHS announced the distribution of more than $2 billion in Provider Relief Fund (PRF) Phase 4 General Distribution payments. These payments bring the Phase 4 distribution total to approximately $11 billion of the...more
The No Surprises Act (the Act), enacted December 27, 2021, will take effect on January 1, 2022. The No Surprises Act puts into place important patient protections from surprise medical bills, while imposing significant...more
12/23/2021
/ Affordable Care Act ,
Department of Health and Human Services (HHS) ,
Disclosure Requirements ,
Employee Retirement Income Security Act (ERISA) ,
Health Care Providers ,
Medicaid ,
Medicare ,
Medicare Advantage ,
No Surprises Act (NSA) ,
Reimbursements ,
Surprise Medical Bills
On July 29, 2021, CMS issued final rules for FY 2022 in its yearly update to Medicare payment policies under the Skilled Nursing Facility (SNF) prospective payment system (PPS), Inpatient Rehabilitation Facilities (IRFs) PPS,...more
8/5/2021
/ Centers for Disease Control and Prevention (CDC) ,
Centers for Medicare & Medicaid Services (CMS) ,
Coronavirus/COVID-19 ,
DMEPOS ,
Healthcare Workers ,
Medicare ,
Patient-Driven Payment Model (PDPM) ,
Prospective Payment System (PPS) ,
Psychiatric Hospitals ,
Public Health Emergency ,
Rehabilitation Act ,
Skilled Nursing Facility