Articles and Blogs

Last week, the United States Court of Appeals for the Seventh Circuit (“Court of Appeals”) released an opinion that confirmed a Centers for Medicare & Medicaid Services (“CMS”) assessment of an immediate jeopardy citation and an $83,800 civil money penalty against a nursing home for inadequately addressing sexual interactions between cognitively impaired nursing home... READ MORE

On November 29, 2018, Deputy Attorney General Rod Rosenstein announced some significant changes to the Department of Justice’s (“DOJ’s”) policies on investigating corporate wrongdoing. These changes pull back some of the guidance that was first announced in a public memorandum issued by former Deputy Attorney General Sally Quillian Yates (“Yates Memo”) in 2015, especially... READ MORE

Compliance professionals live in a world of constant change. As new laws are passed, new regulations are finalized, and public health crises emerge, compliance professionals are expected to guide their organizations through uncharted territory to the destinations chosen by other leaders. Although predicting the future is impossible, compliance priorities rarely develop in isolation. This article surveys significant compliance landmarks from 2018 to help compliance professionals plan for... READ MORE

On October 24, 2018, Congress enacted a new law titled the Eliminating Kickbacks in Recovery Act of 2018 (“EKRA”) as part of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act of 2018 (“SUPPORT Act”). The SUPPORT Act is a comprehensive law that seeks to combat the opioid... READ MORE

On November 21, 2018, the Department of Health and Human Services Office of Inspector General (“OIG”) released a report (“Report”) outlining what it believes are multiple deficiencies in the Medicare wage index system. OIG recommended several changes, including revisiting the possibility of comprehensive reform and seeking authority to penalize hospitals that submit inaccurate wage... READ MORE

The Centers for Medicare & Medicaid Services (“CMS”) recently issued a proposed rule (“Proposed Rule”) that would require pharmaceutical manufacturers to disclose the list price for a typical course of treatment of prescription drugs and biologics covered by Medicare or Medicaid in direct-to-consumer television advertisements. This policy development comes just two months after the... READ MORE

NATIONAL Amazon adds to its list of HIPAA-eligible machine learning tools Leapfrog releases Fall 2018 safety grades showing medical errors, safety issues prevail in red and blue states Hospital CEOs Agree That Systemness Focus Drives Results Doctors as disruptors? AMA CEO says medicine’s future demands it 93% of MIPS-eligible clinicians to get positive payment... READ MORE

Health and Human Services (“HHS”) Secretary Alex Azar announced on Thursday, November 8, 2018 that HHS intends to reconsider some of the episode-based payment models that it withdrew almost one year ago. According to Secretary Azar, HHS is exploring new and improved episode-based payment models, including a mandatory bundled payment model for radiation oncology.[1]... READ MORE

On November 1, 2018, the Centers for Medicare & Medicaid Services (“CMS”) released its final rule for the Calendar Year (“CY”) 2019 Medicare Physician Fee Schedule (“MPFS Final Rule”). Among many other changes, CMS finalized maintaining payments for certain non-excepted (non-grandfathered) off-campus provider-based hospital departments (“PBDs”) at 40 percent of the Outpatient Prospective Payment... READ MORE

The Centers for Medicare & Medicaid Services (“CMS”) Center for Medicare and Medicaid Innovation proposed to lower the cost of Medicare Part B outpatient prescription drugs by establishing their prices based on lower drug prices of other advanced industrial nations as compiled in an “international price index” (“IPI”) and changing the way the current drug... READ MORE