Howard Young on Centers for Medicare & Medicaid Services (CMS)

DOJ and HHS Announce Joint False Claims Act Working Group

The US Departments of Justice and Health and Human Services recently issued a press release on the formation of a new False Claims Act Working Group, signaling to the healthcare industry an increased focus on anti-fraud...more

7/8/2025 / Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Department of Justice (DOJ) , Enforcement Actions , Enforcement Priorities , False Claims Act (FCA) , Healthcare , Healthcare Fraud , Medicaid , Medicare

Courts Diverge in Challenges to CMS's Minimum Staffing Requirements for LTC Facilities

On May 10, 2024, the Centers for Medicare and Medicaid Services (CMS) published its Final Rule to implement minimum staffing standards for long-term care (LTC) facilities in the United States. However, as discussed in our...more

4/30/2025 / Administrative Procedure Act , Appeals , Centers for Medicare & Medicaid Services (CMS) , Final Rules , Healthcare Facilities , Long Term Care Facilities , Nursing Homes , Regulatory Authority

Tick-Tock: CMS Overpayment Refund Final Rule and Practical Implications

The Centers for Medicare & Medicaid Services issued its long-anticipated final rule clarifying the 60-day overpayment refund obligation (the 60-Day Rule) first established in a 2016 regulation for Medicare Part A and B...more

12/23/2024 / Centers for Medicare & Medicaid Services (CMS) , False Claims Act (FCA) , Final Rules , Health Care Providers , Medicare Part A , Medicare Part B , Overpayment

How the US Election May Affect Drug Pricing, Medicare, and Medicaid Programs – Key Areas to Watch

Heading into the new year, a Trump-Vance administration will control the White House and the Republicans will hold a narrow majority in both the House and Senate. This control trifecta is likely to impact both legislative and...more

12/5/2024 / Centers for Medicare & Medicaid Services (CMS) , Drug Pricing , Inflation Reduction Act (IRA) , Manufacturers , Medicaid , Medicare , Medicare Beneficiaries , Medicare Part B , Medicare Part D , Pharmaceutical Industry , Pharmacy Benefit Manager (PBM) , Prescription Drugs , Section 340B , Trump Administration

CMS Proposes Additional Revisions to the 60-Day Rule

The Centers for Medicare & Medicaid Services has issued its Calendar Year 2025 Medicare Physician Fee Schedule Proposed Rule, scheduled for publication in the Federal Register on July 31, 2024. In response to industry...more

7/25/2024 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicare , Physician Fee Schedule , Physicians

Hospice Update: March Goes Out Like a Lion

The old adage—March comes in like a lion and goes out like a lamb—didn’t quite hold true for the hospice sector, which experienced a late-month flurry of activity. The government gave the hospice sector a lot to consider,...more

4/3/2024 / Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Health Care Providers , Hospice , Medicare

Medicare’s New Dementia GUIDE Model: How Can Physicians, Hospices, and Home Health Agencies Participate?

If you have had a loved one suffer from dementia, you know the emotional, physical, and financial toll of this terrible disease. With advancements in dementia treatment, however, there is renewed hope on addressing this...more

3/4/2024 / Centers for Medicare & Medicaid Services (CMS) , Dementia , Health Care Providers , Home Health Care , Medicare

Florida Healthcare Director Charged in Fraud Case Against CMS

Continuing its recent slate of high-profile indictments, convictions, and plea agreements involving healthcare executives who have violated federal healthcare laws, the US Department of Justice (DOJ) recently announced...more

1/15/2024 / Centers for Medicare & Medicaid Services (CMS) , Department of Justice (DOJ) , Health Care Providers , Healthcare Fraud , Medicare , Popular

CMS Increases Hospice Scrutiny through Provider Enrollment and Oversight Tools

The US Centers for Medicare & Medicaid Services (CMS) has implemented a final rule, effective November 13, 2023, designed to enhance the oversight of hospice providers throughout the United States and increase regulatory...more

11/6/2023 / Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Health Care Providers , Medicare , Physicians

Hospice in the Crosshairs: Medicare’s Enhanced Oversight and Newly Announced Audit Pilot

For over a year, the hospice industry, legislators, and state and federal regulators have expressed concerns about the fast growth and potentially unscrupulous activities of new hospices in several states in particular. Those...more

7/17/2023 / Audits , Centers for Medicare & Medicaid Services (CMS) , Hospice , Medicare , SMRC

Hospice General Inpatient Services (GIP): New OIG Audit Alert

The HHS Office of Inspector General (OIG) announced on June 15, 2023 that it plans to initiate a new audit of Medicare payments for hospice general inpatient (GIP) services, focused on hospice GIP services furnished to...more

6/21/2023 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Hospice , Medicare , OIG , SMRC

How the End of the PHE Will Impact the Healthcare Industry

The Biden administration announced on January 30, 2023 that the COVID-19 Public Health Emergency (PHE) would officially end on May 11, 2023. The PHE declaration, which first was issued by the Secretary of the US Department of...more

5/11/2023 / Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Emergency Use Authorization (EUA) , Food and Drug Administration (FDA) , Life Sciences , Medicare , OCR , Public Health Emergency , Telehealth

HHAs and Hospices: What to Expect When the COVID-19 PHE Ends

COVID-19 significantly affected home-based care providers, such as home health agencies (HHAs) and hospices, whose staff had to overcome both physical and mental burdens of going into patients’ homes to deliver care,...more

4/24/2023 / Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Health Care Providers , Home Health Care , Hospice , Public Health Emergency

CMS Proposes Small but Significant Change to 60-Day Overpayment Refund Rule

In a proposed rule issued on December 27, 2022 to make technical changes to the Medicare Advantage Program, the Centers for Medicare and Medicaid Services (CMS) buried in the regulatory arcana a material legal change to the...more

1/18/2023 / Centers for Medicare & Medicaid Services (CMS) , False Claims Act (FCA) , Health Care Providers , Medicare Advantage , Medicare Part A , Medicare Part B , Prescription Drugs

CMS Omnibus COVID-19 Healthcare Staff Vaccination Rule – A First Look

The CMS Healthcare Staff Vaccination Rule takes aim at ensuring that eligible healthcare workers are soon vaccinated against COVID-19. The interim final rule requires providers and suppliers to fully implement the IFR as a...more

11/9/2021 / Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Employer Mandates , Healthcare Facilities , Healthcare Workers , Infectious Diseases , Interim Final Rules (IFR) , OSHA , Vaccinations , Workplace Safety

MA Audit: Hospices Unaware of Dual Eligibles Medicaid Filing Rule, Causing Potential Overpayments

The US Department of Health and Human Services, Office of Inspector General (OIG) recently transmitted a memorandum to the Center for Medicaid and CHIP Services detailing the findings of the Massachusetts state auditor's...more

11/3/2021 / Centers for Medicare & Medicaid Services (CMS) , Children's Health Insurance Program (CHIP) , Hospice , Medicaid , Medicare , OIG , Overpayment

CMS Relaunches Hospice TPE Audits with Long-Stay General Inpatient Reviews

The Centers for Medicare and Medicaid Services (CMS) announced that it had restarted the Targeted Probe and Educate (TPE) audit process, effective September 1, 2021. More recently, the Medicare Administrative Contractors for...more

10/20/2021 / Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Department of Health and Human Services (HHS) , Health Care Providers , Hospice , Medicare , OIG

CMS About to Relaunch Its TPE Audits After a Long COVID-19 Public Health Emergency Pause

A notable headline from the August 12 MLN Connects Newsletter for healthcare providers states “CMS Resumes Targeted Probe & Educate Program.” Designed to help providers reduce claim denials and appeals, CMS suspended...more

8/16/2021 / Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Health Care Providers , Public Health Emergency , Targeted Probe and Education (TPE) audit

CMS to Restart Medicare Audits Beginning August 3

The Centers for Medicare and Medicaid Services (CMS) recently announced that it intends to resume both prepayment and postpayment medical reviews conducted by the Medicare Administrative Contractors, Supplemental Medical...more

7/20/2020 / Audits , Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Independent Medical Review , Medicare , Regulatory Requirements , Relief Measures

Staying Within the Legal Lane: Providing Products and Services for COVID-19

Companies marketing products or services for coronavirus (COVID-19) should be aware of key areas of healthcare law and regulation, including Food and Drug Administration regulation, clinical laboratory testing oversight,...more

7/9/2020 / Centers for Medicare & Medicaid Services (CMS) , Clinical Laboratory Testing , Coronavirus/COVID-19 , Department of Health and Human Services (HHS) , Food and Drug Administration (FDA) , Immunity , Product Defects , Public Readiness and Emergency Preparedness Act (PREP Act) , Risk Mitigation , Suppliers , Supply Chain , Telehealth

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