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Physicians Medicare Hospice

King & Spalding

CMS Proposes Increases to Hospice Care Rates for FY 2026

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On April 11, 2025, CMS issued a proposed rule that “would update the hospice wage index, payment rates, and cap amount for FY 2026” as required under the Social Security Act, clarify payment regulations on admission to...more

Arnall Golden Gregory LLP

Healthcare Authority Newsletter - February 2025 #3

News Briefs - Proposed Budget Cuts Could Greatly Impact Healthcare Sector - House Republicans unveiled a budget resolution that asks the Energy and Commerce Committee, which oversees Medicare and Medicaid, to find $880...more

Arnall Golden Gregory LLP

Healthcare Authority Newsletter - November 2024 #3

News Briefs - New FDA Guidelines Aim to Make TV Drug Ads Clearer, More Direct - The ever-present TV drug ads showing patients hiking, biking, or enjoying a day at the beach could soon have a different look, as new rules...more

Husch Blackwell LLP

Hospice Insights Podcast - Meet the New Laws, Same as the Old Laws: Overpayment Recoupment Update

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Hospices that have been audited have to decide how to address any alleged overpayment identified by the auditor, whether through a voluntary repayment, recoupment, or applying for an extended repayment schedule. CMS recently...more

Arnall Golden Gregory LLP

Healthcare Authority Newsletter - October 2024 #2

News Briefs - 75% of Hospitals Spending More on Tech to Boost Cybersecurity - Three-quarters of hospitals and health systems spent more on information technology last year and many will continue to do so, with greater focus...more

Dentons

Ep. 32 – An Easy Audit Tip to Help Avoid Overpayments

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Looking for a simple, easy-to-implement way to lower your risk of overpayments? We have one on this week’s podcast!...more

Arnall Golden Gregory LLP

Third Circuit Resurrects FCA Lawsuit Against Hospice Due to Disputed Materiality of Eligibility Documentation

A New Jersey hospice provider must continue its long fight against whistleblowers alleging it violated the False Claims Act (“FCA”) by seeking Medicare reimbursement for patients whose documentation did not support hospice...more

Arnall Golden Gregory LLP

Healthcare Authority Newsletter - August 2023 #1

News Briefs - More States Introducing 'Conscience' Healthcare Bills - A new Montana law will provide sweeping legal protections to healthcare practitioners who refuse to prescribe marijuana or participate in procedures and...more

Health Care Compliance Association (HCCA)

News Briefs: July 2023

Report on Medicare Compliance Volume 32, no 25 (July 2023) Hospices in four states will face heightened oversight. “CMS is placing newly enrolling hospices located in Arizona, California, Nevada, and Texas in a provisional...more

Health Care Compliance Association (HCCA)

[Virtual Event] Healthcare Enforcement Compliance Conference - November 7th - 9th, 8:55 am - 3:30 pm CST

Hear directly from the enforcement community - Want to gain insight into properly monitoring, detecting, investigating, and managing violations? Join us virtually at HCCA’s Annual Healthcare Enforcement Compliance...more

Husch Blackwell LLP

You’ve Got Mail: CMS Physician Outreach and How to Respond to It

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The Centers for Medicare & Medicaid Services (CMS) has recently started mailing letters inviting physicians to one-on-one training sessions about the Medicare hospice benefit. In this episode, Husch Blackwell’s Meg Pekarske,...more

Husch Blackwell LLP

Hospice Audit Series: The Latest Developments and Strategies for Success in the Ever-changing Audit Landscape

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Hospice Audits Series Audits are a fact of life for hospices—it’s not a matter of “if” a hospice will be audited, but “when.” The alphabet soup of audits has expanded, from UPICs to SMRCs, CPIs, TPEs and more. With the...more

Faegre Drinker Biddle & Reath LLP

SCOTUS Denies Certiorari in Cases Concerning FCA Liability Requirement, Objective Falsity Circuit Split Remains Intact

The United States Supreme Court denied certiorari without comment in two cases seeking to resolve a Circuit split regarding the proof required to establish that a claim for payment was false or fraudulent under the False...more

Bass, Berry & Sims PLC

Supreme Court Declines to Weigh in on Key Falsity Question

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For several years, courts have wrestled with the question of whether subjective clinical decisions regarding the type and amount of treatment patients may need can be false for purposes of establishing False Claims Act (FCA)...more

Bradley Arant Boult Cummings LLP

Justices Should Weigh In On FCA Objective Falsity Standard

In its conference on Feb. 19, the U.S. Supreme Court is scheduled to consider two pending petitions for certiorari that could resolve a critical but deeply disputed issue that impacts both the False Claims Act and health care...more

Husch Blackwell LLP

Perspectives on End of Life Care: An Exploration of Its Past, Present and Future - A Conversation with Dr. Janet Bull

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As we approach the 40th anniversary of the Medicare hospice benefit, we stand at an important reflection point to evaluate end-of-life care and map its future. In this new series, we gather leaders and thinkers from a range...more

Husch Blackwell LLP

COVID-19 Hospice How-To Series: Hospice Physicians are Being Tested by COVID-19, and Increased Scrutiny Lies Ahead—What to Expect...

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COVID-19 has affected all aspects of hospice care, operations and personnel, including the person whose judgment is at the center of the Medicare hospice benefit: the hospice physician. From new regulations addressing...more

Mintz - Health Care Viewpoints

Third Circuit Rejects AseraCare’s “Objective Falsity” Requirement, Allows Scrutiny of Medical Opinions in Hospice False Claims Act...

Last week, the Third Circuit joined several other appellate courts in finding that medical opinions related to medical necessity of hospice services can be subject to scrutiny and found to be “false” for purposes of proving a...more

Foley & Lardner LLP

Third Circuit Creates Budding Circuit Split in United States v. Care Alternatives, Ruling That “Objective Falsity” Is Not Required...

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The United States Court of Appeals for the Third Circuit ruled last week that whistleblower relators need not show “objective falsity” to prove their claims, and that a dispute among physician experts about a clinical...more

Foley & Lardner LLP

AseraCare FCA Ruling Is A Boon For Health Providers

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All hospice providers routinely should assess risk exposure under the False Claims Act — now with the benefit of the U.S. Court of Appeals for the Eleventh Circuit’s long-awaited decision in United States v. AseraCare Inc. ...more

Bass, Berry & Sims PLC

Healthcare Transactions: Year in Review - January 2020

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Discover the factors that drove healthcare M&A activity in 2019. Innovation, expansion and continued private equity investment in the industry influenced healthcare transactions last year. 2019 saw continued robust...more

Akin Gump Strauss Hauer & Feld LLP

11th Circuit’s Decision in AseraCare: Important in Determining When Clinical Judgment Regarding Medical Necessity Can Result in an...

• Reasonable disagreement among clinicians, by itself, does not result in a false claim. • Clinical judgment must be objectively false to constitute an FCA violation. • A clinical judgment may only be objectively false...more

Latham & Watkins LLP

11th Circuit: Difference in Opinion Not Enough for FCA Liability

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The 11th Circuit’s long-awaited AseraCare opinion requires more than mere disagreement regarding clinical judgment to prove falsity under the False Claims Act. The 11th Circuit rejected the government’s theory of falsity...more

King & Spalding

AseraCare Saga Illustrates the Importance of Internal Compliance

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On September 9, 2019, the Eleventh Circuit issued a highly anticipated opinion addressing the critical question of when Medicare claims for reimbursement (in this case, claims for hospice care) can be considered “false” under...more

Baker Donelson

Disagreements over a Medical Judgment Cannot Form the Basis for Liability Under the False Claims Act

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A new federal court decision offers a ray of light to those providers defending false claims actions based on an alleged lack of medical necessity. On September 9, 2019, the United States Court of Appeals for the Eleventh...more

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