Articles and Blogs

On November 10, 2014, the Centers for Medicare & Medicaid Services (“CMS”) published the amended final rule regarding the expansion exception process for physician-owned hospitals (“2015 Final Rule”).  The 2015 Final Rule will take effect on January 1, 2015. Background Under the Affordable Care Act’s (“ACA’s”) amendments to the Stark Law, a physician-owned hospital... READ MORE

CMS recently released the display copy of the OPPS/ASC Final Rule for CY 2015 which finalizes proposals related to the reporting of services provided in hospital off-campus provider-based departments (“PBDs”).  The Final Rule can be found here. The changes require hospitals to identify services provided in off-campus PBDs through use of a new HCPCS... READ MORE

Executive Summary On October 31, 2014, the Office of Inspector General (“OIG”) published its Work Plan (“Plan”) for Fiscal Year (“FY”) 2015.  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 provider compliance risk areas and providing focus for... READ MORE

On October 31, 2014, the Centers for Medicare & Medicaid Services (“CMS”) issued a final notice approving Lake Pointe Medical Center’s (“Lake Pointe”) request for an exception to the Affordable Care Act’s (“ACA’s”) expansion limitations imposed on physician-owned hospitals. Background Under the ACA’s amendments to the Stark Law, a physician-owned hospital cannot expand the... READ MORE

On October 30, 2014, CMS issued its pre-released copy of the Final CY 2015 Home Health Prospective Payment System Rule (“Final Rule”). The Final Rule adopts many of the proposals found in the proposed regulations that were published by CMS earlier this year (“Proposed Rules”). Notably, the Final Rule also contains CMS’s responses to... READ MORE

The recent report by the Institute of Medicine on the United States graduate medical education system, Graduate Medical Education That Meets the Nation’s Health Needs1 (“IOM Report”), advances many structure reform themes that have appeared in other assessments in recent years.  However, it goes much further.  The IOM Report calls for fundamental changes to... READ MORE

On Friday, October 24, 2014, the IRS released an advance version of Notice 2014-67, (1) adding a new 5-year safe harbor to Revenue Procedure 97-13 (“Rev. Proc. 97-13”) and providing for the inclusion of quality-based incentive payments in management and service contracts for facilities financed with tax-exempt bond proceeds; and (2) offering interim guidance for... READ MORE

As the first quarantine period in Texas passes without additional infections, the focus is on improving preparedness for Ebola while ensuring accurate information is made available to the public. To support preparedness efforts, the CDC and other health care organizations have taken steps to provide health care organizations and providers around the country with critical... READ MORE

Executive Summary In recently issued, virtually identical Advisory Opinions Nos. 14-07 and 14-08, the Department of Health and Human Services Office of the Inspector General (“OIG”) opined that licensed insurers offering Medigap policies to Medicare beneficiaries may contract with preferred hospital organization network hospitals for discounted Medicare inpatient deductibles and, in turn, issue premium... READ MORE

Overview The Department of Health & Human Services Office of Inspector General (“OIG”) recently released a Special Advisory Bulletin on the fraud and abuse implications of pharmaceutical manufacturers offering copayment coupons to reduce or eliminate the cost of out-of-pocket copayments for brand-name drugs.  The Special Advisory Bulletin and the concurrent OIG Office of Evaluations and... READ MORE