Articles and Blogs

On November 16, 2015, the Centers for Medicare & Medicaid Services (“CMS”) issued a public inspection copy of the “Final Rule” related to the Comprehensive Care for Joint Replacement (“CJR”) Model.  Also on November 16, CMS and the Office of the Inspector General (“OIG”) jointly issued notice of waivers of certain fraud and abuse laws... READ MORE

The Department of Health and Human Services Office of Inspector General (“OIG”) issued a report in June1 that is the equivalent of a “strongly worded letter” to the Centers for Medicare & Medicaid Services (“CMS”) for not implementing OIG’s past recommendations to prevent and combat fraud in the Medicare Part D Program (“Program”).  In July,... READ MORE

The U.S. Department of Justice (“DOJ”) recently announced a $2.3 million settlement1 with a Hospital in Massachusetts (“Hospital”) to resolve allegations of Hospital’s failure to provide controls and safeguards against controlled substance diversion in violation of the Controlled Substances Act (“CSA”).2 According to the DOJ’s press release, this is the largest settlement related to... READ MORE

Last week, CMS promulgated a final rule that creates a new “timeshare license” exception to the Stark Law. A few days ago, we reported on this and other changes here but believe that the timeshare topic merits additional discussion. The new exception was created due to the difficulty hospitals and physicians experience when trying... READ MORE

Executive Summary On November 2, 2015, the Office of Inspector General (“OIG”) published its Work Plan for Fiscal Year (“FY”) 2016 (“Plan”).  The Plan, which is published annually and describes OIG’s new and ongoing audit and enforcement priorities for the upcoming year, is helpful in identifying corporate compliance risk areas and providing focus for... READ MORE

The Department of Health and Human Services Office of Inspector General (“OIG”) recently issued Advisory Opinion 15-13,1 which provided a favorable opinion of a health system’s (“Requestor’s”) proposed arrangement to offer free transportation services to patients in a rural community (“Arrangement”). OIG stated that it would not impose sanctions against Requestor for violations of the... READ MORE

A trend in real estate-related False Claims Act litigation should put hospitals and other health care providers on notice that relators are looking for big paydays for non-compliant real estate arrangements. The relators described in this article are real estate professionals who are bringing technically complex claims with little to no institutional knowledge of... READ MORE

Last week, Congress passed the Bipartisan Budget Act of 2015 (“Budget”), and President Obama signed the Budget into law on November 2, 2015.  Among many other changes, the Budget includes an impending exclusion on hospital coverage for off-campus hospital outpatient departments that first bill for services on or after November 2, 2015.  Even though site-neutral payment... READ MORE

On October 30, 2015, the Centers for Medicare & Medicaid Services (“CMS”) released the CY 2016 final rule for revisions to Payment Policies under the Physician Fee Schedule (“Final Rule”) following the proposed rule published in July 2015 (“Proposed Rule”).1  Among other Stark Law revisions, the Final Rule updates the Stark Law regulations for... READ MORE

Overview On October 30, 2015, the Centers for Medicare & Medicaid Services (“CMS”) issued the final rule (“Final Rule”) in follow up to the proposed rule published in July 2015 (“Proposed Rule”).1  It is anticipated that the final regulations will be published in the Federal Register on November 16, 2015.  The Final Rule establishes two new... READ MORE