On July 14, 2025, CMS issued a proposed rule that identifies and seeks public comment on a variety of proposed changes to the Medicare Physician Fee Schedule (PFS), Medicare Shared Savings Program Requirements, and Medicare...more
On April 9, 2025, President Trump issued an executive order, titled “Reducing Anti-Competitive Regulatory Barriers” (the EO), directing federal agencies to identify and rescind or modify anticompetitive regulations. The EO...more
4/24/2025
/ Antitrust Division ,
Competition ,
Department of Justice (DOJ) ,
Deregulation ,
Executive Orders ,
Federal Trade Commission (FTC) ,
Government Agencies ,
Healthcare ,
Regulatory Reform ,
Regulatory Requirements ,
Rulemaking Process
On November 19, 2024, a bipartisan pair of senators, Sen. Charles E. Grassley (R-Id.) and Sen. Elizabeth Warren (D-Ma.) united again, a year after a similar letter, to urge the Internal Revenue Service (IRS) to increase...more
A recent OIG report found that diagnoses reported in 2022 Medicare Advantage (MA) encounter data based only on health risk assessments (HRA) and HRA-linked chart reviews resulted in CMS making additional risk-adjusted...more
On July 10, 2024, CMS issued a proposed rule that identifies and seeks public comments on a broad array of proposed changes to the Medicare Physician Fee Schedule (PFS) and Medicare Part B payments (the Proposed Rule) for...more
7/22/2024
/ Centers for Medicare & Medicaid Services (CMS) ,
Hospitals ,
Medicare ,
Medicare Part B ,
Mental Health ,
Opioid ,
Physician Fee Schedule ,
Prescription Drugs ,
Proposed Rules ,
Substance Abuse ,
Telehealth
CMS’s Hospital Price Transparency regulations require hospitals to make public the standard charges of the items and services that they provide. In the CY 2024 Hospital Outpatient Prospective Payment System Final Rule (CY...more
Last week, the California Hospital Association (CHA), which represents more than 400 hospitals, filed a lawsuit against Anthem Blue Cross (Anthem) alleging that Anthem’s untimely arrangement for, and authorization of,...more
On December 4, 2023, CMS issued an interim final rule (the Interim Rule) (RIN 0938-AV26) to implement new enforcement authorities that CMS may use if states fail to comply with new reporting requirements or with federal...more
12/15/2023
/ Centers for Medicare & Medicaid Services (CMS) ,
Civil Monetary Penalty ,
Coronavirus/COVID-19 ,
Enforcement ,
Families First Coronavirus Response Act (FFCRA) ,
FMAP ,
Interim Final Rules (IFR) ,
Medicaid ,
Public Health Emergency ,
Reporting Requirements ,
Social Security Administration (SSA)
On October 11, 2023, CMS published a final rule (the Final Rule) regarding how and when CMS will impose civil monetary penalties (CMPs) for Medicare secondary payers (MSPs) that untimely report required information. The Final...more
10/19/2023
/ Audits ,
Centers for Medicare & Medicaid Services (CMS) ,
Civil Monetary Penalty ,
Employer Group Health Plans ,
Final Rules ,
Medicare ,
Medicare Beneficiaries ,
Medicare Secondary Payer Act ,
Reimbursements ,
Social Security Act ,
Statute of Limitations
On September 20, 2023, the Departments of Health and Human Services, Labor, and the Treasury (the Departments) announced the Federal Independent Dispute Resolution (IDR) Process Administrative Fee and Certified IDR Entity Fee...more
On August 3, 2023, the Texas Medical Association (TMA) was granted summary judgment in its challenge to (1) the $350 CY 2023 administrative fee for the No Surprises Act’s Independent Dispute Resolution (IDR) process and (2) a...more
House Republicans have announced their intent to cut federal funding for training new pediatricians to hospitals that perform gender-affirming care on minors. The proposed bill, sponsored by Rep. Dan Crenshaw (R-Texas), would...more
In a unanimous opinion, the Supreme Court in United States ex rel. Schutte v. SuperValu Inc., No. 21-111, 2023 WL 3742577 (U.S. June 1, 2023) found that liability in False Claims Act (FCA) suits depends on the defendants’...more
On March 29, 2023, OIG posted Advisory Opinion No. 23-03 regarding a laboratory’s proposed arrangement to provide a prepaid card of up to $75 to encourage individuals to return the sample collection kit associated with the...more
On February 16, 2023, the U.S. District Court for the Northern District of Indiana rejected certain hospitals’ challenge to CMS’s calculation of uncompensated care (UCC) payments eligible to hospitals that treat low-income...more
On September 27, 2022 and October 3, 2022, CMS announced additional resources and flexibilities available for Florida and South Carolina in response to the aftermath of Hurricane Ian.
Following the President’s...more
On May 6, 2022, the Centers for Medicare & Medicaid Services (CMS) approved state plan amendments submitted by Tennessee and South Carolina through which those states will now provide 12 months of continuous postpartum...more
Last week, OIG posted Advisory Opinion No. 22-06 regarding a biopharmaceutical company’s (BioPharm Co.) arrangement to provide free genetic testing and genetic counseling services to patients potentially eligible for...more
On January 21, 2022, Georgia sued HHS over its withdrawal of the approval of the work requirement policy as a requirement for Medicaid eligibility in the Georgia Pathways to Coverage demonstration. As previously reported, in...more
On November 2, 2021, CMS put on display its final rule that, among other things, updates the home health and home infusion therapy services payment rates for calendar year (CY) 2022; makes significant changes to the provider...more
11/17/2021
/ Centers for Medicare & Medicaid Services (CMS) ,
Final Rules ,
Healthcare ,
Healthcare Reform ,
Home Health Care ,
Hospice ,
Inpatient Prospective Payment System (IPPS) ,
Inpatient Quality Reporting ,
Inpatient Rehab Facilities ,
Long Term Care Facilities ,
Medicare ,
Regulatory Requirements ,
Therapeutic Services ,
Value-Based Purchasing
On September 30, 2021, OIG posted Advisory Opinion No. 21-14 regarding a chiropractor’s proposal to extend an existing discount program covering a package of services to include federal health care program beneficiaries. OIG...more
10/14/2021
/ Advisory Opinions ,
Anti-Kickback Statute ,
Beneficiary Inducement ,
Civil Monetary Penalty ,
Discounts ,
Healthcare ,
Medicare ,
Medicare Part B ,
OIG ,
Payment Systems ,
Physician Medicare Reimbursements
Last week, OIG posted Advisory Opinion No. 21-08 regarding a pharmaceutical manufacturer’s arrangement to provide financial assistance in the form of transportation, lodging, and meals to patients potentially eligible for...more
On June 17, 2021, in California v. Texas, the Supreme Court rejected a challenge to the Patient Protection and Affordable Care Act (ACA) for the third time in nine years. Texas, 17 other states, and two individuals brought...more
6/24/2021
/ Affordable Care Act ,
Article III ,
California v Texas ,
Commerce Clause ,
Individual Mandate ,
Medicaid ,
NFIB v. Sebelius ,
SCOTUS ,
Standing ,
Tax Cuts and Jobs Act ,
Trump Administration
Last week, OIG posted Advisory Opinions Nos. 21-03, 21-04, and 21-05 relating to three near-identical arrangements between Medigap plans and Preferred Hospital Organizations (PHOs). The arrangements involve (i) a discount on...more