On April 7, 2025, the United States District Court for the Northern District of Texas ruled in favor of the American Health Care Association (“AHCA”) in its lawsuit against Health and Human Services (“HHS”) Secretary Robert...more
In this episode, AGG Healthcare attorneys Bill Dombi and Jason Bring discuss recent OIG guidance on hospice and skilled nursing facility relationships, focusing on anti-kickback risks and fraud concerns. They cover key issues...more
In this episode, AGG Healthcare attorneys Bill Dombi and Jason Bring discuss the hospice special focus program and CMS’ announcement that it will cease implementing the program in the face of litigation filed by providers and...more
A group of four state associations and a hospice provider have filed a federal lawsuit in Texas challenging the Special Focus Program (“SFP”) Final Rule and the resulting list of hospices identified as poor performers. The...more
AGG’s Government Investigations Team Insights provides periodic updates covering legal and regulatory topics. Our team, which includes former federal prosecutors, SEC enforcement attorneys, and federal agency attorneys, has...more
7/23/2024
/ Administrative Authority ,
Administrative Law Judge (ALJ) ,
Artificial Intelligence ,
Drug Trafficking ,
Expert Testimony ,
Expert Witness ,
False Claims Act (FCA) ,
Federal Rules of Civil Procedure ,
Fraud ,
Government Agencies ,
Government Investigations ,
Health Care Providers ,
Jury Trial ,
Medicare ,
Qui Tam ,
Regulatory Authority ,
SCOTUS ,
SEC v Jarkesy ,
Securities and Exchange Commission (SEC) ,
Statutory Authority ,
Whistleblowers
On June 27, 2024, the Supreme Court of the United States released its opinion in SEC v. Jarkesy, a case involving a Securities and Exchange Commission (“SEC”) enforcement action for civil penalties against an investment...more
7/3/2024
/ Administrative Appeals ,
Administrative Authority ,
Administrative Law Judge (ALJ) ,
Administrative Proceedings ,
Department of Health and Human Services (HHS) ,
Healthcare ,
Jury Trial ,
Medicaid ,
Medicare ,
OMHA ,
SCOTUS ,
SEC v Jarkesy ,
Securities and Exchange Commission (SEC) ,
Securities Fraud ,
Seventh Amendment
In the wake of the government-wide sequestration cuts in 2011, the hospice industry was not spared. Medicare hospice payments were reduced by two percent in accordance with a sequestration order issued March 1, 2013, pursuant...more
An August 2020 report by the U.S. Department of Health and Human Services Office of the Inspector General recommended that the U.S. Centers for Medicare & Medicaid Services (CMS) revamp its use of the hospital wage index to...more
CMS has announced a series of temporary regulatory waivers and new rules to provide hospice providers with flexibility to respond to the COVID-19 pandemic. The goals of these actions are to expand the healthcare system...more
CMS Announces Hospice Capitation Rates for Medicare Advantage -
The U.S. Centers for Medicare and Medicaid Services (CMS) recently released the capitation rates for hospice care through the value-based insurance design...more
The U.S. Centers for Medicare and Medicaid Services (CMS) recently released the capitation rates for hospice care through the value-based insurance design model (VBID), often referred to as the Medicare Advantage hospice...more
Every year, health lawyers, providers, consultants, and government experts from across the country convene in Baltimore for the American Health Lawyers Association’s Institute on Medicare and Medicaid Payment Issues, the most...more
On Friday, September 14, 2018, U.S. District Judge Steven Merryday for the Middle District of Florida sentenced Dr. John Janick of Port Charlotte to five months in prison and three years of supervised release, plus...more
Medicare’s implementation of post-payment review through overly aggressive zone program integrity contractors (ZPICs) and unified program integrity contracts (UPICs), combined with an ineffective review process at the first...more
Medicare’s implementation of post-payment review through overly aggressive private contractors, combined with an ineffective review process at the first two levels of the administrative appeal process (redetermination and...more
Medicare’s implementation of post-payment review through private contractors who are overly aggressive in denying payments, combined with an ineffective review process at the first two levels of administrative appeal...more
On July 13, 2017, the Department of Justice, in conjunction with the Department of Health and Human Services, announced the largest series of health care charges in American history. The government charged 412 individuals,...more
People in this country have long enjoyed the right to contract. Included with that right is the ability to agree to resolve potential disputes out of court and in arbitration. The Centers for Medicare & Medicaid Services’...more
Medicare’s implementation of post-payment review through private contractors who are overly aggressive in denying payments, combined with a severe backlog of cases in queue for hearing before an Administrative Law Judge...more
11/11/2015
/ Administrative Appeals ,
Administrative Law Judge (ALJ) ,
Centers for Medicare & Medicaid Services (CMS) ,
Due Process ,
Hospice ,
Medicare ,
Medicare Provider Agreements ,
OMHA ,
RAC Audits ,
Recoupment ,
Recovery Audit Contractors (RACs)
During the 90-day public comment period on the Center for Medicare & Medicaid Services (CMS) proposed rule entitled “Reform of Requirements for Long-Term Care Facilities” which closed October 14, 2015, CMS received nearly...more
In July, the Centers for Medicare & Medicaid Services (CMS) proposed changes to the requirements for long-term care facilities, including implementation of new restrictions on the use of binding arbitration agreements between...more