John Tilton on Medicare

District Court Elucidates the Meaning of “to Induce” Under the Federal Health Care Program Anti-Kickback Statute

The United States District Court for the Eastern District of Virginia recently dismissed an appeal by the Pharmaceutical Coalition for Patient Access (“PCPA”) that challenged a negative opinion issued by the U.S. Department...more

2/28/2024 / Advisory Opinions , Anti-Kickback Statute , Beneficiaries , Department of Health and Human Services (HHS) , Healthcare , Healthcare Reform , Medicare , Medicare Part D , OIG , Pharmaceutical Industry

Medicare Advantage RADV Audit Final Rule Challenged in Court

The Centers for Medicare & Medicaid Services (“CMS”) released the final rule on risk adjustment data validation (“RADV”) audits of Medicare Advantage (“MA”) organizations (the “Final Rule”) on January 30, 2023. Among other...more

9/28/2023 / Centers for Medicare & Medicaid Services (CMS) , Final Rules , Medicare , Medicare Advantage , Medicare Advantage Organizations (MAOs)

CMS Announces Changes to ACO REACH Model

On August 14, 2023, the Centers for Medicare & Medicaid Services (CMS) released guidance on changes to the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model starting in performance...more

9/12/2023 / Centers for Medicare & Medicaid Services (CMS) , CMMI , Health Insurance , Innovation , Medicare , New Regulations , REACH , Regulatory Agenda

CMS Announces Proposed Rule for 2024 Medicare Physician Fee Schedule

On July 13, 2023, the Centers for Medicare & Medicaid Services (“CMS”) issued its proposed rule (the “Proposed Rule”) for the 2024 Medicare Physician Fee Schedule (“PFS”). The Proposed Rule, which was issued in the Federal...more

8/14/2023 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicare , Physician Fee Schedule , Physician Medicare Reimbursements , Physicians , Proposed Rules

CMS Issues Long-Awaiting Medicare Advantage RADV Final Rule

On January 30, 2023, the Centers for Medicare & Medicaid Services (“CMS”) released the long-delayed final rule on risk adjustment data validation (“RADV”) audits of Medicare Advantage (“MA”) organizations (the “Final...more

2/2/2023 / Audits , Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Final Rules , Medicare , Medicare Advantage , Medicare Advantage Organizations (MAOs) , OIG , Overpayment Recovery Time Limits

OIG Warns Telehealth Industry: “With Great Power Comes Great Responsibility”

On February 4, 2021, the Department of Justice (“DOJ”), Office of Public Affairs, issued a Press Release (the “DOJ Press Release”) announcing that Kelly Wolfe, President of Regency, Inc., a medical billing company located in...more

3/11/2021 / Anti-Kickback Statute , Coronavirus/COVID-19 , Department of Justice (DOJ) , Durable Medical Equipment , False Claims Act (FCA) , Fraud , Healthcare Fraud , Medicare , OIG , Settlement , Telehealth , Telemedicine

The Other Shoe Drops: OIG To Audit COVID-19 Telehealth Home Health Services

In response to the ongoing COVID-19 public health emergency (the “PHE”) first declared on March 13, 2020, the Centers for Medicare & Medicaid Services (“CMS”) issued blanket Section 1135 Waivers to expand, albeit on a...more

2/1/2021 / 1135 Waivers , Audits , Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Home Health Care , Medicare , OIG , Public Health Emergency , Telehealth , Waivers

CMS’s Mandatory Radiation Oncology Payment Model: Negative Reactions in the Radiation Oncology Treatment Community

On July 10 2019, the Centers for Medicare & Medicaid Services (“CMS”) issued a Notice of Proposed Rulemaking (“NPR”) entitled, “Medicare Program; Specialty Care Models to Improve Quality of Care and Reduce Expenditures.” In...more

10/29/2019 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Hospitals , Medicare , Patient Access and Medicare Protection Act , Payment Systems , Quality of Care Standards

John Tilton

Sheppard Mullin Richter & Hampton LLP

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