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 Friday, October 6, 2023, OIG announced the results of an audit performed on the Medicare Part A hospital transfer policy for discharges to post-acute care (PAC). The hospital transfer policy, which was established in...more
On July 28, 2023, CMS issued a final rule (CMS-1787-F) updating Medicare hospice payment rates and the aggregate cap amount applicable to fiscal year 2024 (the Final Rule). According to CMS, the Final Rule is part of CMS’s...more
On February 28, 2023, a jury in the United States District Court in Minnesota issued a $43 million verdict in favor of the plaintiffs in United States ex rel. Fesenmaier v. Cameron-Ehlen Grp, a False Claims Act (FCA) suit...more
Lawsuits challenging the CMS Interim Final Rule (IFR) on COVID-19 vaccine requirements for healthcare workers and Occupational Safety and Health Administration’s (OSHA) COVID-19 Emergency Temporary Standards on Health Care...more
11/24/2021
/ Administrative Procedure Act ,
Appeals ,
Centers for Medicare & Medicaid Services (CMS) ,
Congressional Review Act ,
Coronavirus/COVID-19 ,
Employer Mandates ,
Healthcare Workers ,
Interim Final Rules (IFR) ,
Medicaid ,
Medicare ,
OSHA ,
Social Security Act ,
Vaccinations
On July 27, 2020, Senate Republicans released their plan for the next phase of coronavirus relief. Instead of a single bill, the Senate plan (dubbed the Health, Economic Assistance, Liability Protection, and Schools Act, or...more
8/10/2020
/ CARES Act ,
Centers for Disease Control and Prevention (CDC) ,
Coronavirus/COVID-19 ,
Department of Health and Human Services (HHS) ,
Medicare ,
Nursing Homes ,
Personal Protective Equipment ,
Popular ,
Public Schools ,
Relief Measures ,
Skilled Nursing Facility ,
Telehealth ,
Virus Testing
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 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