Articles and Blogs

On December 14, 2016, the Department of Justice (“DOJ”) released a report on fraud statistics regarding recovery amounts for False Claims Act (“FCA”) violations in fiscal year 2016 (“Report”). Reaching $4.7 billion from settlements and judgments, this year’s recovery is the third highest annual recovery in FCA history. Health care fraud accounts for a substantial…Read More

On December 20, CMS posted for public inspection a final rule establishing three new Episode Payment Models (“EPMs”). Two of the EPMs pertain to cardiac care. The third EPM pertains to orthopedic care.  CMS will officially publish the rule on January 3, 2017. The Cardiac-Related EPMs The first cardiac-related EPM is for episodes of care…Read More

The Department of Health and Human Services Office of Inspector General (“OIG”) recently issued Advisory Opinion 16-11,1 which provided a favorable opinion of a Medicare Supplemental Health Insurance plan’s (the “Plan’s”) proposed arrangement (the “Arrangement”) through which a preferred hospital network would offer Plan policyholders (“Policyholders”) who elect to use a network hospital for inpatient…Read More

The Department of Health and Human Services Office of Inspector General (“OIG”) recently issued Advisory Opinion 16-12, determining that a proposed arrangement for a laboratory to provide test tube and specimen collection container labeling to dialysis facilities had the potential to violate the Anti-Kickback Statute (“AKS”). Background The requesting laboratory (“Requestor”) provides certain laboratory testing…Read More

This is another article in a series discussing the complete overhaul of Part 483 to Title 42 of the Code of Federal Regulations, the Requirements for States and Long-Term Care Facilities (“Final Regulations”) by the Centers for Medicare & Medicaid Services (“CMS”). Background On September 28, 2016, CMS released a complete overhaul of Part 483…Read More

While the holidays are upon us and many are traveling over the valley and through the wood, the Wisconsin Department of Quality Assurance (“DQA”) has issued a notice reminding health care providers that there is no time off from the reporting requirements under Wisconsin Statutes §457.25(1). This statute, and several like it, apply to any…Read More

The 21st Century Cures Act passed the U.S. House of Representatives on November 30, 2016 with a 392 to 26 margin and passed the U.S. Senate on December 7, 2016 with an 85 to 13 margin. The $6.3 billion health care bill is expected to be signed by President Obama on December 13, 2016. Above…Read More

Congress Passes 21st Century Cures Bill On December 7, the Senate passed the sweeping 21st Century Cures bill (H.R. 34), clearing the way for it to be signed into law. The Senate vote comes a week after House passage of the $6.3 billion medical research funding bill that makes comprehensive mental health reforms and provides…Read More

On December 8, 2016, the Centers for Medicare & Medicaid Services (“CMS”) posted the final Office of Management and Budget (“OMB”) approved version of the Medicare Outpatient Observation Notice (“MOON”) on its Beneficiary Notices Initiative website. CMS indicated that hospitals and critical access hospitals (“CAHs”) are required to provide the MOON to applicable patients beginning…Read More

On December 7, 2016, the Senate passed the 21st Century Cures Act (H.R. 34) (“Cures Act”), which, among many other changes, revises Section 603 of the Bipartisan Budget Act of 2015 (“Section 603”) to provide an exception for off-campus provider-based departments (“PBDs”) that were mid-build or under development prior to November 2, 2015. The Cures…Read More