Timothy Fry on Medicare

CMS Proposes Reimbursement Changes for Remote Patient Monitoring

On July 14, 2025, the Centers for Medicare & Medicaid Services (CMS) issued the 2026 Medicare Physician Fee Schedule (PFS) Proposed Rule (PFS Proposed Rule). The PFS Proposed Rule proposes to reduce requirements for several...more

8/22/2025 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Health Information Technologies , Medicare , Physician Fee Schedule , Proposed Rules , Regulatory Requirements , Reimbursements , Telemedicine

Seventh Circuit Allows Percentage-Based Marketing Relationship

On April 14th, 2025, the U.S. Court of Appeals for the Seventh Circuit reversed the Anti-Kickback Statute (AKS) conviction of Mark Sorensen, the owner and operator of a Medicare-registered durable medical equipment...more

8/21/2025 / Advertising , Anti-Kickback Statute , Appeals , Department of Justice (DOJ) , Healthcare Fraud , Marketing , Medicare , Medicare Fraud , OIG

OIG Approves Multi-MSO Telehealth Arrangement That Meets AKS Safe Harbor

On June 6, 2025, the U.S. Department of Health and Human Services Office of Inspector General (OIG) issued a favorable advisory opinion concerning a proposed telehealth staffing and services arrangement involving a management...more

7/11/2025 / Anti-Kickback Statute , Contract Terms , Medicaid , Medicare , OIG , Physicians , Safe Harbors , Telehealth

Fifth Circuit Concurrence Adds Voice to FCA Constitutionality Questions

A first appellate circuit judge has questioned the False Claim Act’s constitutionality. In the Fifth Circuit’s decision last month in United States ex rel Montcrief v. Peripheral Vascular Assocs., P.A., No. 24-50176, — F....more

4/11/2025 / Appeals , Appointments Clause , Constitutional Challenges , False Claims Act (FCA) , Government Agencies , Healthcare Fraud , Medicare , Qui Tam , Whistleblowers

First Circuit Adopts “But For” AKS Standard, Leaving Third Circuit Alone in Causal-Link Standard

On Feb. 18, 2025, the U.S. Court of Appeals for the First Circuit adopted the “but for” causality standard for violations of the federal Anti-Kickback Statute (AKS) that give rise to violations of the federal False Claims Act...more

3/5/2025 / Anti-Kickback Statute , Appeals , Causation , Department of Justice (DOJ) , False Claims Act (FCA) , Healthcare Fraud , Medicare , Pharmaceutical Industry , Relators

CMS Opinion Offers Guidance on Relocation of Physician-Owned Hospitals

On Feb. 26, 2025, McGuireWoods successfully assisted a physician-owned hospital in obtaining a favorable advisory opinion from the Centers for Medicare & Medicaid Services (CMS) regarding its proposal to relocate the entire...more

3/4/2025 / Advisory Opinions , Centers for Medicare & Medicaid Services (CMS) , Hospitals , Medicare , Physician-Owned Hospitals , Stark Law

CMS Nearly Doubles Prior Stark Self-Disclosure Dollar Record in 2024

The Centers for Medicare & Medicaid Services (CMS) recently released data on its 2024 settlements of voluntary self-disclosures related to past violations or potential violations of the physician self-referral law (the Stark...more

3/4/2025 / Centers for Medicare & Medicaid Services (CMS) , Disclosure Requirements , Enforcement Actions , Health Care Providers , Healthcare Fraud , Medicaid , Medicare , Physicians , Stark Law

OIG Recommends Increased RPM Oversight

On September 24, 2024, the Department of Health and Human Services Office of Inspector General (“OIG”) published a report (the “Report), reviewing and recommending increased oversight of remote patient monitoring (“RPM”)...more

11/15/2024 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicare , OIG , Patients

Ounce of Prevention: Do You Know When Your DMEPOS Surety Bonds Expire?

Applicable Provider Types: Any individual or entity that receives Medicare reimbursement for selling or renting DMEPOS - Is Your Entity in Compliance? Most durable medical equipment, prosthetics, orthotics and...more

9/26/2024 / Centers for Medicare & Medicaid Services (CMS) , Durable Medical Equipment , Health Care Providers , Medicare , Physicians , Surety Bonds

Ounce of Prevention: Are All Locations Where You Dispense DMEPOS Individually Enrolled in Medicare?

Applicable Provider Types: Any individual or entity that receives Medicare reimbursement for selling or renting DMEPOS...more

9/6/2024 / Centers for Medicare & Medicaid Services (CMS) , DMEPOS , Health Care Providers , Medicare

CMS 2025 Payment Proposals Could Impact Cardiology

The Centers for Medicare & Medicaid Services (CMS) recently published two proposed rules that could affect Medicare reimbursement for cardiology services. On July 22, 2024, CMS published the Calendar Year (CY) 2025 Hospital...more

9/5/2024 / Ambulatory Surgery Centers , Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicare , Outpatient Prospective Payment System (OPPS) , Reimbursements

OIG Plans New Guidance for Medicare Advantage and Nursing Homes

In its General Compliance Program Guidance (GCPG) issued in November 2023, the Office of Inspector General of the U.S. Department of Health and Human Services (OIG) announced its intent to publish industry segment-specific...more

3/26/2024 / Health Care Providers , Medicare , Medicare Advantage , Nursing Homes , OIG

CMS Ends COVID-19 Vaccine Mandate for Medicare- and Medicaid-Certified Providers and Suppliers

On June 5, 2023, the Centers for Medicare & Medicaid Services (CMS) published a final rule in the Federal Register that withdraws COVID-19 vaccination mandates for certain providers’ staff members and withdraws long-term care...more

6/8/2023 / Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Health Care Providers , Long Term Care Facilities , Medicaid , Medicare , Vaccinations

CMS Publicly Releases Ownership Data for Medicare-Certified Hospice and Home Health Agencies

On April 20, 2023, the Centers for Medicare & Medicaid Services (CMS) announced the release of ownership data for all Medicare-enrolled hospice and home health agencies. This release is consistent with the Department of...more

5/3/2023 / Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Health Care Providers , Home Health Care , Hospice , Medicare , Nursing Homes

End of COVID-19 Emergency: Legal Implications for Healthcare Providers

On Jan. 30, 2023, President Joe Biden announced that the COVID-19 public health emergency (PHE) will end May 11, 2023. Under the PHE, the federal government implemented a range of modifications and waivers impacting Medicare,...more

5/2/2023 / CARES Act , Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Department of Health and Human Services (HHS) , Health Care Providers , Health Insurance , Infectious Diseases , Medicaid , Medicare , Public Health Emergency , Telehealth , Telemedicine

Outdated Medicare Enrollment Data? Caution: CMS Verifying Ownership

In recent weeks, the Centers for Medicare & Medicaid Services (CMS) has been contacting certain Medicare-enrolled providers and suppliers (hereinafter “providers”) to verify that their ownership information, as reported in...more

4/27/2023 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicare

CMS Issues ESRD Prospective Payment System Final Rule for 2023

Rule Addresses Rate Increases, Outlier, Add-On and ETC Model Payments, Oral-Only Drugs and QIP Reporting - On Oct. 31, 2022, the Centers for Medicare & Medicaid Services issued a final rule implementing an increase in...more

11/8/2022 / Centers for Medicare & Medicaid Services (CMS) , Dialysis , ESRD , Final Rules , Medicare , Prospective Payment System (PPS)

Will 2022 Be The Year? OIG’s 25 Top Recommendations to Reduce Healthcare Fraud

Every year the U.S. Department of Health and Human Services’ (HHS) Office of Inspector General (OIG) releases an annual Solutions to Reduce Fraud, Waste, and Abuse in HHS Programs: OIG’s Top Unimplemented Recommendations. HHS...more

2/3/2022 / Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Healthcare Facilities , Healthcare Fraud , Medicare , OIG , Skilled Nursing Facility

Provider Relief Fund Reporting Guidance: HHS Grants Reporting Grace Period Until Nov. 30 for Provider Relief Fund

HHS Grants Reporting Grace Period Until Nov. 30 for Provider Relief Fund - The U.S. Department of Health and Human Services (HHS) recently announced a 60-day grace period to allow providers to comply with the Provider...more

9/29/2021 / Coronavirus/COVID-19 , Department of Health and Human Services (HHS) , Health Care Providers , Medicare , Provider Relief Fund , Reimbursements

HHS OIG Targets Ophthalmology Practices for Medicare Billing Compliance: Eight Key Takeaways

One of the most challenging billing compliance issues ophthalmology practices encounter in coding and reimbursement is understanding when services provided on the same day as a surgical procedure are payable separately from...more

4/30/2021 / Billing , Department of Health and Human Services (HHS) , Health Care Providers , Medicare , OIG

CMS Accelerated and Advance Payment Recoupment Begins

Recoupment has started or will soon begin for Medicare Part A and Part B providers and suppliers who received funds in 2020 under the Medicare Accelerated and Advance Payment (AAP) Program. The Centers for Medicare & Medicaid...more

4/7/2021 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicare , Medicare Part A , Medicare Part B

Update: House Passes, President to Sign American Rescue Plan With Senate Healthcare Provisions

On March 10, 2021, the U.S. House of Representatives narrowly passed H.R. 1319, the American Rescue Plan Act of 2021, on a largely partisan basis by a 220-211 vote. Final passage came four days after the U.S. Senate amended...more

3/11/2021 / Affordable Care Act , Coronavirus/COVID-19 , Cost-Sharing , Health Care Providers , Hospitals , Medicare , Relief Measures , Skilled Nursing Facility

U.S. Senate Passes American Rescue Plan – 10 Key Updates for Healthcare Providers

On March 6, 2021, the U.S. Senate narrowly passed H.R. 1319, the American Rescue Plan Act of 2021, by a 50-49 vote, along entirely partisan lines. Sen. Dan Sullivan (R-AK) missed the vote after joining with all Republicans on...more

3/9/2021 / COBRA , Coronavirus/COVID-19 , Department of Health and Human Services (HHS) , Health Care Providers , Hospitals , Medicaid , Medicare , Mental Health , Popular , Rural Health Care Providers , SAMHSA , Skilled Nursing Facility , Vaccinations

Omnibus Appropriations Package – 15 Key Provisions for Healthcare Providers

Passed by Congress Dec. 21, 2020, and signed by President Donald Trump Dec. 27, 2020, the $1.4 trillion omnibus Consolidated Appropriations Act, 2021 (H.R. 133), includes numerous statutory provisions that directly affect...more

1/14/2021 / CARES Act , Centers for Medicare & Medicaid Services (CMS) , Consolidated Appropriations Act (CAA) , Department of Health and Human Services (HHS) , Health Care Providers , Medicare , Physician Fee Schedule , Telehealth

Omnibus Appropriations Package Includes Changes for Medicare and Medicaid Beneficiaries

Passed by Congress Dec. 21, 2020, and signed by President Donald Trump Dec. 27, 2020, the $1.4 trillion omnibus Consolidated Appropriations Act includes numerous provisions that directly impact Medicare and Medicaid...more

1/7/2021 / Centers for Medicare & Medicaid Services (CMS) , Consolidated Appropriations Act (CAA) , Department of Health and Human Services (HHS) , Medicaid , Medicare , Medicare Advantage , Medicare Part A , Medicare Part D

Timothy Fry

McGuireWoods LLP

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