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Secretary Must Again Explain His FY 2004 Outlier Turbo-Charging Rulemaking, D.C. District Court Orders

Following several lines of litigation, a federal court has again ordered the HHS Secretary to justify his FY 2004 outlier rulemaking in light of Administrative Procedure Act requirements. In District Hospital Partners v....more

Medical Records Production Company Sues to Prohibit Enforcement of HIPAA Medical Record Payment Policies

On January 8, 2018, CIOX Health, LLC filed a complaint challenging two HHS policies limiting whether and how much a HIPAA covered entity can charge for providing copies of medical records. According to the lawsuit filed in...more

Laboratory Group Challenges CMS’s Implementation of Clinical Laboratory Commercial Data Reporting Requirements

On December 11, 2017, the American Clinical Laboratory Association (ACLA) filed suit on behalf of its membership against the Secretary of HHS, challenging the Secretary’s implementation of the Protecting Access to Medicare...more

In Targeting Outlier Payment Reconciliation, OIG Calls for an Aggressive Reading of CMS Reopening Regulations

The HHS OIG recently published a report detailing CMS’s and Medicare Administrative Contractor’s (“MACs’”) ongoing issues in the outlier payment reconciliation process. A previous 2012 review identified 465 cost reports that...more

D.C. Circuit Decides Part C DSH Issue in Favor of Providers

On July 25, 2017, the United States Court of Appeals for the District of Columbia Circuit held that HHS violated the terms of the Medicare statute by failing to undertake notice-and-comment rulemaking in implementing its...more

OIG Faults CMS for its Medicare and Medicaid Improper Payment Rates

Under the Improper Payments Information Act of 2002, as amended, the Department of Health and Human Services (HHS) is required to annually report on improper payments and meet certain improvement metrics. In a report...more

MedPAC Votes on Medicare Payment Rate Sufficiency

On January 12, 2017, Medicare Payment Advisory Commission (MedPAC) members unanimously voted to maintain Medicare’s existing updates (i.e., maintain the increases Congress and the HHS Secretary have already established) to...more

HHS Proposes Significant Changes to ALJ Hearing Procedures

HHS announced a Proposed Rule on July 5, 2016 aimed at reducing the backlog of appeals at the Office of Medicare Hearings and Appeals (OMHA) and Departmental Appeals Board (DAB) for Medicare payment and coverage...more

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