Articles and Blogs

The single largest and most unexpected change proposed in the 2018 Proposed PPS Rule is the announcement that the Home Health Groupings Model (“HHGM”) will be implemented as of January 1, 2019. Although the Centers for Medicare & Medicaid Services (“CMS”) released a detailed technical report on the HHGM last fall, the industry did not anticipate…Read More

On August 15, 2017, CMS released for public inspection a proposed rule that would: Cancel the AMI, CABG and SHFFT episode payment models that are currently scheduled to begin on January 1, 2018. Cancel the cardiac rehabilitation incentive payment program that is currently scheduled to begin on January 1, 2018. Revise various aspects of the…Read More

The public disclosure bar remains one of the most important tools for disposing of False Claims Act (“FCA”) claims. The Seventh Circuit’s recent decision in United States ex rel. Bellevue v. United Health Services of Hartgrove, Inc. clarified the effect of the 2010 amendments to the public disclosure bar and affirmed the dismissal of whistleblower allegations…Read More

Just over half a year into the new administration, significant developments have occurred that may permanently alter the landscape of the 340B drug discount program (“340B Program”), developments so significant that the mainstream news media has started to take notice.[1] As 340B Program participating “Covered Entities” and their contract pharmacy partners work to develop their…Read More

NATIONAL 7 statistics on physician compensation — average sign on bonus is $18k Elderly may be blocked from suing nursing homes for neglect, abuse 25% of Physicians Dissatisfied with Provider Compensation Rates 9 hospitals, health systems opening or planning ASCs — July 2017 Non-physician providers, support staff a driving factor behind more profitable physician groups,…Read More

Recently, the Department of Justice (“DOJ”) announced it had entered into a $42 million settlement (“Settlement”)[1] with the owners of a California acute care hospital (“Parent Company”) to resolve allegations that the Parent Company had violated the False Claims Act by submitting false claims to Medicare and MediCal (California Medicaid) programs. The Parent Company is…Read More

CMS Issues 2018 Hospital Payment Rule On August 2, CMS announced the fiscal year (“FY”) 2018 Medicare Inpatient Prospective Payment System and Long-Term Care Hospital (“LTCH”) Prospective Payment System final rule, which will provide acute care hospitals with a total increase in Medicare spending on inpatient hospital payments of $2.4 billion in FY 2018. The…Read More

NATIONAL Health system and physician group alignment: The strategies that don’t work — and those that do New Senate bill seeks to reduce restrictions on telemedicine use The vital role of hospital technology selection in achieving post-merger alignment Amazon has a secret health tech team called 1492 working on medical records, virtual doc visits OIG…Read More

On July 7, 2017, the Survey and Certification Group at Centers for Medicare & Medicaid Services (“CMS”) issued a memorandum, “Revision of Civil Money Penalty (“CMP”) Policies and CMP Analytic Tool” (“S&C Memo”) detailing revisions to policies and the analytic tool used to assess and determine CMPs for skilled nursing facilities. The stated goal is to…Read More

On July 25, 2017, the Court of Appeals for the District of Columbia issued a provider-friendly decision in Allina Health Services v. Price, Case No. 16-5255 (more commonly known as Allina II), reversing the negative decision the hospitals received at the district court level. The court’s reversal stems from its reasoning that the “pre-2004 standard…Read More