On November 12, 2024, OIG published a report concluding that the Medicare program overpaid acute-care hospitals an estimated $190 million over five years for outpatient services provided to hospice enrollees....more
GAO issued a report on December 12, 2022, that identified gaps in the reporting requirements for hospice abuse and neglect allegations as compared with requirements for extended care provided in hospitals and nursing homes....more
On March 11, 2022, OIG issued Advisory Opinion No. 22-05 in which it responded to a request for an advisory opinion regarding a proposed subsidization of certain cost-sharing obligations in the context of a clinical trial...more
4/4/2022
/ Anti-Kickback Statute ,
Centers for Medicare & Medicaid Services (CMS) ,
Clinical Trials ,
Cost-Sharing ,
Manufacturers ,
Medical Devices ,
Medicare ,
Medicare Part D ,
OIG ,
Reimbursements ,
Sanctions
On November 19, 2021, OIG issued Advisory Opinion No. 21-17 in which it responded to a request for an advisory opinion regarding a proposed subsidization of certain Medicare cost-sharing obligations in the context of a...more
On June 24, 2021, CMS sent letters to Arizona and Indiana informing them that the agency has revoked its approval of provisions in their state Medicaid demonstration projects that had required adults to be employed as a...more
On April 7, 2021, CMS issued a proposed rule for the Inpatient Rehabilitation Facility (IRF) Prospective Payment System (PPS) and a proposed rule for the Inpatient Psychiatric Facility (IPF) PPS for fiscal year (FY) 2022. ...more
On August 3, 2020, CMS issued a proposed rule which updates payment policies, payment rates, and other provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2021 (the...more
On November 18, 2019, CMS published the proposed Medicaid Fiscal Accountability Rule (the Proposed Rule) which, if finalized, would result in dramatic changes to the Medicaid program. Through the Proposed Rule, CMS aims to...more
On September 19, 2019, the OIG released a report relating to recent audits of the CHIPRA program. The audits, performed from April 2012 through September 2017, identified over $277 million in unallowable payments made to 12...more
On July 18, 2019, CMS published a proposed rule titled “Medicare & Medicaid Programs; Requirements for Long-Term Care Facilities: Regulatory Provisions to Promote Efficiency and Transparency” (the Proposed Rule). According to...more
On May 2, 2019, CMS issued a proposed rule that would add requirements and a specific process to address changes of ownership as they relate to the sale, transfer, and/or purchase of assets of CMS-approved Accrediting...more
On October 31, 2018, the Centers for Medicare and Medicaid Services (“CMS”) issued a final rule (CMS-1689-FC) (the “Final Rule”) that makes significant changes to the Home Health Prospective Payments System (“PPS”). These...more
On April 27, 2018, CMS issued a proposed rule that would update the payments rates under the prospective payments system (PPS) for skilled nursing facilities (SNFs). Additionally, the proposed rule includes proposals for the...more
Last week, CMS issued a final rule which aims to relax certain Affordable Care Act (ACA) health plan regulations, found at 45 C.F.R. Parts 147, 153, 154, 155, 157, and 158, while increasing marketplace competition. In...more