On Thursday, June 12, 2025, a panel of the United States Court of Appeals for the Fifth Circuit issued two rulings construing parts of the No Surprises Act (NSA) to limit judicial review of arbitration awards issued under the...more
On December 11, 2024, OIG issued a Special Fraud Alert to warn the industry about the fraud and abuse risks associated with abusive Medicare Advantage (MA) organization (MAO) and agent and broker relationships with healthcare...more
12/23/2024
/ Anti-Kickback Statute ,
Civil Monetary Penalty ,
False Claims Act (FCA) ,
Fraud Alerts ,
Fraud and Abuse ,
Health Care Providers ,
Medicare ,
Medicare Advantage ,
Medicare Advantage Organizations (MAOs) ,
OIG ,
Provider Payments
On November 1, 2024, CMS issued a rule finalizing changes to Medicare payments under the Physician Fee Schedule (PFS) and other Medicare Part B policies effective on or after January 1, 2025 (the Final Rule). Section 1848 of...more
11/20/2024
/ Biosimilars ,
Centers for Medicare & Medicaid Services (CMS) ,
Controlled Substances ,
Final Rules ,
Food and Drug Administration (FDA) ,
FQHC ,
HCPCS ,
Health Care Providers ,
Inflation Reduction Act (IRA) ,
Infrastructure Investment and Jobs Act (IIJA) ,
MACs ,
Medicare ,
Medicare Part B ,
Mental Health ,
New Legislation ,
Opioid ,
Physician Fee Schedule ,
Popular ,
Prescription Drugs ,
Public Health Emergency ,
Risk Assessment ,
Risk Management ,
Rural Health Care Providers ,
Social Security Act ,
Substance Abuse ,
Telecommunications ,
Telehealth ,
Vaccinations
On December 28, 2021, HHS released a proposed rule governing plans issued in the Patient Protection and Affordable Care Act (ACA) marketplaces beginning with the 2023 plan year (the Proposed Rule). Among other changes to the...more
On May 3, 2021, HHS announced a new program to cover the costs of COVID-19 vaccination for patients enrolled in health plans that either do not cover vaccinations generally, or cover them but with patient cost-sharing...more
On January 21, 2021, the HHS Office for Civil Rights (OCR) published a notice of proposed rulemaking (the Proposed Rule) proposing modifications to the HIPAA Privacy Rule to address standards that might impede the transition...more
CMS recently announced updates and milestones for several programs run by the Center for Medicare and Medicaid Innovation (CMMI). CMMI is the internal CMS agency responsible for developing and testing new health care payment...more
1/20/2020
/ Alternative Payment Models (APM) ,
Centers for Medicare & Medicaid Services (CMS) ,
CMMI ,
Fee-for-Service ,
Health Care Providers ,
Hospitals ,
Medicare ,
Medicare Access and CHIP Reauthorization (MACRA) ,
Next Generation ACO (NGACO) ,
Physicians ,
Quality Payment Program (QPP)
On July 10, 2019, CMS announced a new proposal for episode-based payment for radiation oncology services. The aim of this new proposal is to determine whether episode-based payment to hospitals, physician groups, and...more
On Monday, June 24, 2019, President Trump issued an executive order requiring HHS and other agencies to propose regulations designed to promote transparency and upfront disclosure by hospitals to patients of the charge prices...more
On April 5, 2019, CMS issued final rules (the Final Rule) implementing various provisions of the 2018 Bipartisan Budget Act (the 2018 Budget). The 2018 Budget includes provisions allowing Medicare Advantage plans to provide...more