This post is part one of two in a series on new transparency requirements impacting both health plans and health care providers.
In an effort to assist patients in understanding the cost of hospital services, the Hospital...more
As promised, this is a follow-up to our first blog post on the new federal transparency requirements. In our prior post, we summarized the Hospital Price Transparency rule which went into effect on January 1, 2021, and here...more
A recent Fourth Circuit decision, United States v. Mallory (988 F.3d 730), upheld damages and penalties for more than $100 million for violations of the Anti-Kickback Statute (42 U.S.C. § 1320a-7b(b)) (the “AKS”) and the...more
The Department of Health and Human Services (“HHS”), in collaboration with the Centers for Medicare & Medicaid Services (“CMS”) and the Office of the Inspector General (“OIG”), has issued two final rules clarifying certain...more
The recently enacted Consolidated Appropriations Act, 2021 (the “Act”) not only funds the government and provides further relief in regard to the impact of the COVID-19 pandemic, but it also adopted a number of new...more
New York State has enacted amendments to provisions of the Social Services Law governing the compliance program requirements applicable to Medicaid providers. These changes generally took immediate effect on April 1, 2020,...more
[co-author: Daniel Weinstein] -
CARES Act, Payroll Protection, and Medicare Advance Payment Programs -
This document was last updated on July 20, 2020 to reflect changes made by the Department of Health and Human...more
7/20/2020
/ CARES Act ,
Coronavirus/COVID-19 ,
Department of Health and Human Services (HHS) ,
False Claims Act (FCA) ,
Federal Funding ,
Health Care Providers ,
Paycheck Protection Program (PPP) ,
Paycheck Protection Program and Health Care Enhancement Act ,
Relief Measures ,
SBA ,
SBA Lending Programs
[co-author: Daniel Weinstein]
CARES Act, Payroll Protection, and Medicare Advance Payment Programs -
This document was last updated on July 7, 2020 to reflect changes made by the Department of Health and Human Services to...more
[co-author: Daniel Weinstein]
In response to widespread cash flow issues resulting from the COVID-19 public health emergency, Congress enacted two key pieces of legislation: the CARES Act and the Paycheck Protection...more
6/10/2020
/ Attorney General ,
CARES Act ,
Compliance ,
Coronavirus/COVID-19 ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Health Care Providers ,
Infectious Diseases ,
Medicare ,
OIG ,
Paycheck Protection Program (PPP) ,
Paycheck Protection Program and Health Care Enhancement Act ,
Provider Relief Fund ,
SBA ,
Secretary of HHS ,
Whistleblowers
On April 30, 2020, the Centers for Medicare & Medicaid Services ("CMS") issued its Second Interim Final Rule in response to the COVID-19 pandemic, which includes additional regulatory waivers and rule changes. After reviewing...more
Less than a month after passing the $2.0 trillion Coronavirus Aid, Relief, and Economic Security Act of 2020 (the “CARES Act”), Congress has passed and the President has signed a second round of aid (the Paycheck Protection...more
Less than a month after passing the $2.0 trillion Coronavirus Aid, Relief, and Economic Security Act of 2020 (the "CARES Act"), Congress has passed and the President has signed a second round of aid (the Paycheck Protection...more
In yet another example of coronavirus-related regulatory dispensation, on March 30, 2020, CMS announced that it will waive penalties for violations of the Stark Law in regard to compensation relationships between physicians...more
On March 9, 2020, the Centers for Medicare and Medicaid Services ("CMS") and the Office of the National Coordinator for Health Information Technology ("ONC") each released final rules generally intended to ease both access to...more
On October 9, 2019, the Department of Health and Human Services ("HHS") issued proposed changes to the regulations implementing the Physician Self-Referral Law (the "Stark Law"), the Anti-Kickback Statute (the "AKS"), and the...more
10/15/2019
/ Anti-Kickback Statute ,
Centers for Medicare & Medicaid Services (CMS) ,
Civil Monetary Penalty ,
Department of Health and Human Services (HHS) ,
EHR ,
Exceptions ,
Health Care Providers ,
Healthcare Reform ,
OIG ,
Proposed Amendments ,
Stark Law ,
Value-Based Care
On December 7, 2016, the Department of Health and Human Services (HHS), Office of Inspector General (OIG), issued a final rule that will have a widespread impact on health care service providers, medical transport providers,...more
12/16/2016
/ Ambulance Providers ,
Anti-Kickback Statute ,
Civil Monetary Penalty ,
Cost-Sharing ,
Department of Health and Human Services (HHS) ,
FQHC ,
Generic Drugs ,
Health Care Providers ,
Healthcare ,
Low-Income Issues ,
Medicaid ,
Medicare ,
Medicare Advantage Organizations (MAOs) ,
Medicare Part B ,
OIG ,
Pharmacies ,
Remuneration ,
Rural Areas ,
Safe Harbors ,
TRICARE ,
Veterans Administration
On April 27, 2016, just over a year after the Medicare Access and CHIP Reauthorization Act (MACRA) was signed into law, the Department of Health and Human Services (HHS) unveiled the long-awaited proposed rule to begin its...more
On November 2, 2015, President Obama signed into law H.R. 1314, the Bipartisan Budget Act of 2015 (the "Act"), which significantly changes Medicare reimbursement for off-campus hospital services. The Act, which Congress...more
11/5/2015
/ Barack Obama ,
Congressional Budget Office ,
Federal Budget ,
Health Care Providers ,
Healthcare ,
Hospitals ,
Medicare ,
New Legislation ,
OPPS ,
Physician Fee Schedule ,
Reimbursements
On April 16, 2015, President Obama signed into law H.R.2, the Medicare Access and CHIP Reauthorization Act of 2015 (the "Act"), which provides for sweeping changes to how Medicare pays doctors. Specifically, the Act seeks to...more
Yesterday, the Supreme Court heard oral argument in King v. Burwell, which some describe as an argument over a mere four words – "established by the state." But to the surprise of many, the Justices did not spend most of the...more
On August 7, 2014, Judge Castel of the Southern District of New York dismissed a False Claims Act (“FCA”) complaint that was based primarily on allegations that the defendant Hospital improperly focused on referral revenue in...more
As the July 1, 2014 compliance date of the New York Nonprofit Revitalization Act of 2013 (the "Revitalization Act") quickly approaches, many charities operating in New York are confronting some difficult rollout challenges....more
Implementing Executive Order 38, which was issued by Governor Andrew Cuomo early last year, thirteen New York State agencies have released final regulations placing limits on state funds that can be used for administrative...more
On March 26, the HHS Office of Inspector General (OIG) issued a Special Fraud Alert (Fraud Alert) reiterating its long-standing concern that the opportunity for a referring physician to earn a profit by investing in a venture...more
Implementing Executive Order 38 issued by Governor Cuomo early in 2012, thirteen New York State agencies have again released revised proposed regulations placing a limit on the funds that can be used for administrative...more