Articles and Blogs

Earlier today, at an annual meeting of tax professionals, Internal Revenue Service (“IRS”) TE/GE Commissioner Sunita Lough remarked that the IRS recently completed and provided Congress a report on the activities of tax-exempt and other hospitals. Under Internal Revenue Code Section 4959, the Treasury Department or its designee must review the community benefit activities of every Code Section 501(c)(3) hospital at... READ MORE

The Department of Health and Human Services Office of Inspector General (“OIG”) recently issued Advisory Opinion 15-01,1 which provided a favorable opinion of an arrangement that offered Medicaid beneficiaries free diapers and playpens if the beneficiaries chose a provider’s program for the state’s Maternal Infant Health Program (“Arrangement”). OIG found that the Arrangement did... READ MORE

Executive Summary In response to the 2012 meningitis outbreak traced to tainted injections compounded by the New England Compounding Center, OIG recently published a study entitled “Medicare’s Oversight of Compounded Pharmaceuticals Used in Hospitals: OEI-1-13-0040” (“Study”).  OIG made the following findings: State survey agencies and accreditation agencies (e.g., The Joint Commission, HFAP, DNV, Center... READ MORE

OIG recently issued Advisory Opinion 15-02, which clarified OIG’s position on when federal health care program payments to an excluded individual could be permissible. The proposed arrangement involved a physician who had an ownership interest in a group medical practice. The group practice billed federal health care programs for services the physician performed before... READ MORE

CMS recently issued Advisory Opinion CMS-AO-2014-01 (“Opinion”)1 evaluating the methodology used to determine the percentage of the requesting hospital’s physician ownership as of March 23, 2010 (“Baseline Physician Ownership”).  Even though the requesting hospital executed a contribution agreement prior to March 23, 2010, CMS concluded that such action did not affect the percentage of Baseline... READ MORE

By this point, it is no secret that the federal and state antitrust enforcers are suspicious of providers’ rationales for the provider consolidation wave hitting the health care industry.  In their view, provider consolidation in highly concentrated markets leads to increased prices for hospital and physician services paid by commercial payers, which, in turn,... READ MORE

To be published in the February 17, 2015 Federal Register, CMS has extended its deadline for finalizing the Affordable Care Act’s (“ACA”) 60-day payback rule. This is the rule that requires a Medicare or Medicaid provider to return an identified overpayment within 60 days of its identification. On day 61, the overpayment becomes a violation of the... READ MORE

The Timeline Recently, HHS Secretary Sylvia Burwell announced an ambitious timeline for transitioning away from the fee-for-service payment system to one based on value.  Specifically, HHS’s goal is for 30% of all Medicare provider payments to be in “alternative payment models” by 2016 and for 50% of Medicare provider payments to be in alternative... READ MORE

This article has been republished with permission from the American Health Law Association. On December 31, the Food and Drug Administration (FDA) issued a guidance stating that it will delay enforcement of certain new product tracing requirements, included in the recently enacted Drug Supply Chain Security Act (DSCSA), until May 1. The delayed requirements... READ MORE

CMS recently published a notification on its website in response to inquiries regarding the annual reporting requirement for physician-owned hospitals.  In the notification, CMS expressed concerns about the quality of the data collected for the CY 2014 annual report and noted that it would further examine the details of the report prior to publication. ... READ MORE