Erica Kraus on Centers for Medicare & Medicaid Services (CMS)

CMS Finalizes Rule Expanding its Authority to Deny and Revoke Medicare Program Enrollment, Among Other Changes

On September 5, 2019, the Centers for Medicare and Medicaid Services (“CMS”) released a final rule with comment period entitled, “Program Integrity Enhancements to the Provider Enrollment Process” (the “Final Rule”). The...more

9/11/2019 / Ambulance Providers , Centers for Medicare & Medicaid Services (CMS) , Comment Period , Enrollment , Final Rules , Health Care Providers , Healthcare Fraud , Home Health Agencies , Hospice , Hospitals , Medicaid , Medicare , Physicians , Public Comment , Revocation , Skilled Nursing Facility , Suppliers

CMS Issues Long-Awaited Draft Guidance for Hospital Co-Location with Other Hospitals or Healthcare Facilities

On May 3, 2019, the Centers for Medicare and Medicaid Services (“CMS”) released long-awaited draft guidance (the “Guidance”), proposing to allow hospitals to co-locate with other hospitals or healthcare facilities in certain...more

5/10/2019 / Centers for Medicare & Medicaid Services (CMS) , Comment Period , Draft Guidance , Emergency Rooms , EMTALA , Health Care Providers , Healthcare Facilities , Hospitals , Medicare , Patient Safety , Policies and Procedures , Shared Space Arrangements

CMS’ Medicare Advantage Overpayment Rule: Arbitrary, Capricious, and Vacated

In a key case being watched by the industry, Judge Collyer of the United States District Court for the District of Columbia issued an opinion today granting UnitedHealthcare’s Motion for Summary Judgment in UnitedHealthcare...more

9/10/2018 / Administrative Procedure Act , Affordable Care Act , Centers for Medicare & Medicaid Services (CMS) , False Claims Act (FCA) , Medicare , Medicare Advantage , Medicare Advantage Organizations (MAOs) , Medicare Part D , Overpayment

Star Ratings and Future Measurement Concepts in the CY 2019 Final Call Letter

Medicare Part C and Part D Star Ratings are used by CMS to measure the quality of and reflect the experiences of beneficiaries in Medicare Advantage (“MA”) and Prescription Drug Plans (“PDPs”). Below is a summary of CMS’...more

4/12/2018 / Centers for Medicare & Medicaid Services (CMS) , Data Integrity , Medicare , Medicare Advantage , Medicare Part C , Medicare Part D , Opioid , Prescription Drug Coverage , Star Ratings

MACRA Quality Payment Program Final Rule: Implications for 2018 and Beyond

On November 2, 2017, CMS published its final rule (the “Final Rule”) on the 2018 Quality Payment Program (“QPP”), authorized by the Medicare Access and CHIP Reauthorization Act of 2015 (“MACRA”). This final rule adopted many...more

11/30/2017 / CEHRT , Centers for Medicare & Medicaid Services (CMS) , Final Rules , Health Care Providers , Medicare , Medicare Access and CHIP Reauthorization (MACRA) , Medicare Part B , Nurse Practitioners , Quality Payment Program (QPP) , Threshold Requirements

MACRA Update: How to Prepare for Changes in MIPS

As we reported last month, CMS’ proposed rule updating MACRA’s Quality Payment Program (“QPP”) for CY 2018 would extend and expand exceptions that would allow many practitioners to avoid participating in its Merit-based...more

9/11/2017 / Alternative Payment Models (APM) , CEHRT , Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicare Access and CHIP Reauthorization (MACRA) , MIPS , Physician Medicare Reimbursements , Quality Payment Program (QPP) , Threshold Requirements

The MACRA Final Rule: The Art of the Transition

On Friday, October 14, 2016, CMS released the much-anticipated final rule (the “Final Rule”) implementing the Quality Payment Program (QPP), mandated by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). ...more

10/19/2016 / ACOs , Alternative Payment Models (APM) , Centers for Medicare & Medicaid Services (CMS) , Final Rules , Medicare Access and CHIP Reauthorization (MACRA) , Medicare Part B , MIPS , Provider Payments , Quality Payment Program (QPP)

The Overpayment Rule and the Implied False Claims Theory: “What You Don’t Know Can Still Hurt You”

In 2010, the Affordable Care Act (“ACA”) enacted new rules governing overpayments made by the Medicare and Medicaid programs. Under these rules, providers have 60 days from the date that the overpayment has been identified to...more

7/14/2016 / 60-Day Rule , Affordable Care Act , Centers for Medicare & Medicaid Services (CMS) , False Claims Act (FCA) , False Implied Certification Theory , Health Care Providers , Medicaid , Medicare , Medicare Part A , Medicare Part B , Overpayment , Overpayment Recovery Time Limits , Universal Health Services Inc v United States ex rel Escobar

Erica Kraus

Sheppard Mullin Richter & Hampton LLP

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