Christopher Donovan on Centers for Medicare & Medicaid Services (CMS)

Key Takeaways from the HLTH 2022 Conference

With over 10,000 people in attendance, HLTH 2022 was inspiring and covered a wide range of subjects from health equity to the future of the digital health investment environment. Some sessions were laser-focused on current...more

11/29/2022 / Centers for Medicare & Medicaid Services (CMS) , Data Collection , Digital Health , Mental Health , Substance Abuse , Value-Based Care

2023 Medicare Physician Fee Schedule Advances Access to Whole Person Treatment for Substance Use Disorders and Behavioral Health

Starting January 1, 2023, Medicare will expand and increase coverage of certain services and providers to advance access to prevention and treatment services for substance use disorders (SUD) and mental health services. These...more

11/10/2022 / Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Final Rules , Medicare , Opioid , Physicians , Substance Abuse

Top Trends in Tech-Enabled Home Care

The traditional world of Medicare-certified home health and hospice is changing rapidly. To the surprise of many, though the pandemic has been an accelerant, the reasons are more fundamental, and at the core are forces...more

2/14/2022 / Centers for Medicare & Medicaid Services (CMS) , Data Management , Home Health Care , Hospice , Medicare Advantage , Technology , Telemedicine , Value-Based Care

Medicare Telehealth and Substance Use Disorder Treatment FAQs: New CMS Reimbursement Requirements

In the 12-month period starting in April 2021, over 100,000 people have died from drug overdoses, a 28.5% increase from the same period the year before. While the opioid crisis has been a declared public health emergency...more

1/11/2022 / Centers for Medicare & Medicaid Services (CMS) , Medicare , New Rules , Opioid , Public Health Emergency , Reimbursements , Substance Abuse , Telehealth

PE Firm Pays Record Settlement for Allegedly Deficient Health Services: Identifying Traps for the Unwary

In a Press Release issued on October 14 2021 by the Office of Massachusetts Attorney General Maura Healy, a potentially groundbreaking settlement was announced. Below is an excerpt from the release, followed by our takeaways....more

10/29/2021 / Bad Actors , Centers for Medicare & Medicaid Services (CMS) , Due Diligence , False Claims Act (FCA) , Fraud , Mental Health , Private Equity Firms , Settlement , Unlicensed Medical Providers , Whistleblowers

Home Health and Hospice Joint Ventures: An Accelerating Trend

At the annual Home Care 100 Conference this past week, I had the pleasure of moderating a panel of top executives in the home health, hospice, palliative, and integrated primary care business models discuss leading trends in...more

7/2/2021 / Centers for Medicare & Medicaid Services (CMS) , Home Health Care , Hospice , Medicare Advantage , Reimbursements , Value-Based Care

COVID-19: Three Health Care Sectors Still Attracting Investment

Since President Trump declared a national emergency concerning the Novel Coronavirus Disease (COVID-19) outbreak on March 13, 2020, the health care industry has witnessed increased focus by investors on sectors closely tied...more

5/19/2020 / Artificial Intelligence , Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Donald Trump , Healthcare , Investment , Mental Health , Social Distancing , Telehealth , Telemedicine

Ninth Circuit Holds an “Objective Falsehood” Is Not Required for Violation of False Claims Act

Following the Eleventh Circuit’s and Third Circuit’s recent rulings in United States v. AseraCare and United States v. Care Alternatives, respectively, the Ninth Circuit Court of Appeals has now also addressed the question of...more

4/20/2020 / Appeals , Centers for Medicare & Medicaid Services (CMS) , False Claims Act (FCA) , Qui Tam

COVID-19: Notable Impacts for Post-Acute Providers from the CARES Act, CMS Blanket Waivers, and the CMS Interim Final Rule

Between various blanket Section 1135 waivers and state specific waivers issued by CMS, provisions of the Coronavirus Aid, Relief, and Economic Security Act (the CARES Act) and numerous state, local and accreditation body...more

4/10/2020 / Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Health Care Providers , Interim Final Rules (IFR) , Medicare , Waivers

Health Care MarketTrends - September 2019, Issue 2

Welcome to Foley & Lardner LLP’s Health Care MarketTrends. In this issue, we examine private equity investment in specialty areas of the health care industry, specifically dermatology and orthopedics....more

9/17/2019 / Anti-Kickback Statute , Audits , Billing , Centers for Medicare & Medicaid Services (CMS) , Coding , Health Care Providers , Hospitals , Investors , Medicaid , Medicare , Private Equity , Private Equity Firms , Specialty Healthcare , Stark Law

2019 Health Care Industry Outlook

A new wave of change is poised to disrupt the way health care is delivered in the United States. This time around, the disruption is coming not from lawmakers or the president, who have struggled to repeal or improve upon...more

1/30/2019 / Affordable Care Act , Artificial Intelligence , Centers for Medicare & Medicaid Services (CMS) , Cybersecurity , Department of Veterans Affairs , Drug Pricing , Health Care Providers , Healthcare , Healthcare Reform , Internet of Things , Legislative Agendas , Medicaid , Medicare Advantage , Popular , Request For Information , Stark Law , Telehealth

CMS Recoupment Efforts Stopped by Court While Overpayment Appeals Are Pending

Providers and suppliers who have been assessed overpayments for Medicare services are entitled, by statute, to a stay of recoupment while the provider or supplier’s appeal is pending – but only at the first two levels of...more

7/19/2018 / Administrative Appeals , Administrative Law Judge (ALJ) , Centers for Medicare & Medicaid Services (CMS) , Due Process , Health Care Providers , Medicare , Medicare Provider Agreements , Overpayment , Physician Medicare Reimbursements , Recoupment , ZPIC

6 Key Takeaways for Providers on BPCI-Advanced (Value-Based Medicare Payment)

Despite some initial difficulty in gaining momentum, the use of value-based payment methodologies will likely increase across all provider niches. This change is partly a function of cost savings driven by margin compression...more

3/20/2018 / ACOs , Alternative Payment Models (APM) , BPCI , Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Financial Markets , Health Care Providers , Medicare Access and CHIP Reauthorization (MACRA) , Medicare Shared Savings Program , Skilled Nursing Facility

Christopher Donovan

Foley & Lardner LLP

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