Articles and Blogs

NATIONAL CMS proposes 2020 rate for total knee arthroplasty News report on healthcare billing fraud prompts senators’ call for federal action More than 50% of healthcare providers not compliant with HIPAA right of access 12 healthcare companies that are the highest-paying employers in their state CMS brings controversial star ratings system to ACA plans... READ MORE

On June 14, 2019, the U.S. Department of Health and Human Services (“HHS”) published in the Federal Register a proposal to revise certain civil rights anti-discrimination regulations implementing and enforcing Section 1557 of the Affordable Care Act (“ACA”) (“Section 1557 Rule”) that HHS believes are inconsistent with pre-existing civil rights statutes and likely unlawful... READ MORE

On August 16, 2019, the Federal Fiscal Year (“FFY”) 2020 Medicare Inpatient Prospective Payment System (“IPPS”) final rule (“IPPS Final Rule”) was published in the Federal Register. In the IPPS Final Rule, the Centers for Medicare & Medicaid Services (“CMS”) finalized several changes announced in the proposed rule, including several changes to address disparities between high... READ MORE

On July 11, 2019, the Office of Inspector General (“OIG”) for the U.S. Department of Health and Human Services (“HHS”) released the new Grant Self-Disclosure Program Guidance (“Grant Guidance”) for HHS grant recipients and subrecipients. Through the Grant Guidance, OIG provides new self-reporting options for HHS grant recipients and subrecipients who determine that they... READ MORE

 NATIONAL Allscripts agrees to $145M HIPAA, kickback settlement GAO: PBMs passed on nearly all Part D rebates to plans in 2016 Reduce burnout by putting more doctors in leadership roles: Physicians Foundation Appeals court revives changes to Medicaid DSH payment rules 3 more healthcare organizations notify patients of AMCA data breach, bringing total affected... READ MORE

In the recently issued Physician Fee Schedule Proposed Rule for Calendar Year 2020, the Centers for Medicare & Medicaid Services (“CMS”) proposed several revisions to its Stark Law advisory opinion process. These proposed revisions follow CMS’s receipt of several stakeholder comments in response to its Request for Information Regarding the Physician Self-Referral Law published... READ MORE

Recently, the D.C. District Court ruled that HHS must include certain waiver programs in its Medicare disproportionate share calculations. This is a significant ruling because many states have experimented with different ways to provide health care to low-income populations. As a result, hospitals serving these populations may be entitled to increased payments.[1] Background Under... READ MORE

NATIONAL Best patient experience innovations at 17 health systems DaVita, Fresenius Broke Kickback Rules, Whistleblower Says CMS Finalizes Medicare Pay Increase for Rural Hospital Workers 4 major questions on HHS and FDA’s drug importation action plan New CMS Pilot Program Gives Physicians Claims Data Access HHS Designates $20 Million for New Rural Residency Programs... READ MORE

Recently, Lyft announced that its ridesharing service is now considered a covered benefit under the Arizona Medicaid program. This announcement follows implementation of new Arizona Medicaid regulations allowing ‘”rideshare”‘ companies to enroll as non-emergency medical transportation providers. Under the policy, participating Medicaid patients can request to schedule non-emergency medical transportation to ensure access to... READ MORE

Last week, a federal district court in Illinois entered judgment for Defendants in an FCA action against a self-proclaimed “one stop shop” health care referral management company, alleging anti-kickback and FCA violations for its arrangement with a care coordination organization for low-income seniors.[1] Originally filed in 2016, this case highlights how even an FCA... READ MORE