Articles and Blogs

The Indiana Court of Appeals in ESPN Inc. and Paula Lavigne v. University of Notre Dame et al. held the campus police department at Notre Dame, a private university, was subject to the Indiana Access to Public Records Act (“APRA”).  ESPN and Ms. Lavigne filed a complaint against the University’s Police Department alleging it... READ MORE

In a proposed rule issued on March 11, CMS formally unveiled plans for its Part B Drug Payment Model (the “Model”). The Model would significantly alter how Medicare pays for Part B drugs and biologicals. If finalized, the Model will affect hospital outpatient departments, physicians, nursing facilities and certain DME suppliers. Commencement and Duration... READ MORE

Wisconsin became the twelfth state to enact the Interstate Medical Licensure Compact (“Compact”) into law, which, once implemented, will allow eligible physicians the option of applying for a medical license through an expedited process in Wisconsin and other states participating in the Compact. With physician shortages increasing, the Compact is intended to expand access to... READ MORE

On March 1, 2016, the Department of Justice (“DOJ”) released a statement describing a settlement with the United States’ largest endoscope distributor (“Company”) to resolve civil claims and criminal charges connected to payments and kickbacks made to physicians and hospitals. The Company agreed to pay a total of $623.2 million to settle the criminal... READ MORE

Overview On March 1, 2016, the Centers for Medicare & Medicaid Services (“CMS”) issued a Proposed Rule that would make several sweeping changes to the Medicare screening and enrollment requirements for providers and suppliers. In particular, the Proposed Rule would require providers and suppliers to report certain affiliations with other providers/suppliers that may pose... READ MORE

Executive Summary The Centers for Medicare & Medicaid Services (“CMS”) recently released a memo to Medicare Advantage and Part D plan sponsors (collectively, “Sponsors”) providing additional guidance regarding Compliance Program Effectiveness (“CPE”) training requirements applicable to a Sponsor’s first tier, downstream and related entities (“FDRs”), including a Sponsor’s contracted health care providers and subcontractors.... READ MORE

Overview Since the passage of the Affordable Care Act, all Medicare providers and suppliers have been required to revalidate their Medicare enrollment information under new screening criteria. The Centers for Medicare & Medicaid Services (“CMS”) has implemented this requirement in two cycles. The first cycle of revalidation requests has concluded, and CMS is preparing... READ MORE

Overview In recent years, the Centers for Medicare & Medicaid Services (“CMS”) has been committed to enforcing the requirement that hospitals must be “primarily engaged” in providing inpatient services to be qualified as a hospital under the Social Security Act and thus eligible to participate in Medicare.  This enforcement trend has resulted in the... READ MORE

The Medicare Access and CHIP Reauthorization Act of 2015 (“MACRA”), signed by President Obama in April of 2015, enacted legislation that will significantly impact provider reimbursement. MACRA repealed the Sustainable Growth Rate (“SGR”) formula and implemented: (i) scheduled updates to the Medicare Physician Fee Schedule (“MPFS”) including a 0.5 percent positive annual update beginning... READ MORE

Executive Summary On February 9, 2016, the Substance Abuse and Mental Health Services Administration (“SAMHSA”) issued proposed rules to substantially revise its Confidentiality of Alcohol and Drug Abuse Patient Records regulations (“Proposed Rules”)1.  The last substantive update to these regulations occurred in 1987, nearly 30 years ago, which was before the enactment of the... READ MORE