Articles and Blogs

The 9th Circuit Court of Appeals just issued a blockbuster ruling in U.S. ex rel. Swoben v United Healthcare et al., ruling that United Healthcare, WellPoint, Aetna and other major health insurance providers must answer to a whistleblower’s complaint that they defrauded the Medicare Advantage program. The Medicare Advantage Program, also known as Medicare Part…Read More

On July 22, 2016, the Center for Clinical Standards and Quality/Survey & Certification Group released a memorandum that revised Chapter 7 of the State Operations Manual (“SOM”) and provided guidance on its policy to immediately impose federal remedies when a deficiency of a certain type is cited. The remedies are in addition to a civil…Read More

The Department of Health and Human Services Office of Inspector General (“OIG”) recently issued a favorable Advisory Opinion, No. 16-07, of an arrangement that offers Medicare Part D beneficiaries discounts on prescriptions for an erectile dysfunction drug that is statutorily excluded from coverage under Part D (the “Arrangement”). While OIG concluded that the Arrangement could…Read More

On August 2, 2016, the Centers for Medicare & Medicaid Services (“CMS”) published a Proposed Rule establishing three new mandatory retrospective bundled payment models and creating an incentive payment program for cardiac rehabilitation services. In this Proposed Rule, CMS also outlined several proposed changes to the recently implemented Comprehensive Care for Joint Replacement (“CJR”) program. The…Read More

Background On August 2, 2016, the Centers for Medicare & Medicaid Services (“CMS”) published a proposed rule (the “Proposed Rule“) to create three new episode payment models (“EPMs”) covering services provided to Medicare beneficiaries admitted to certain Inpatient Prospective Payment System (“IPPS”) hospitals for heart attacks, coronary bypass surgery or surgical treatment of hip or…Read More

On August 5, 2016, the Centers for Medicare & Medicaid Services (“CMS”) released a Survey and Certification Memo (“S&C Memo”) on protecting resident privacy and prohibiting abuse-related photographs and recordings by nursing home staff.¹  Recent news stories have reported nursing home staff taking unauthorized photographs or video recordings of nursing home residents, sometimes in compromised…Read More

The Michigan Supreme Court recently declined to review, and thus affirmed, a Michigan Court of Appeals’ (“COA”) decision in which the COA held that Michigan law allows a cause of action for wrongful termination in violation of public policy under MCL 333.20176a(1)(a) of the Public Health Code, which prohibits discharge of employees reporting malpractice by health professionals….Read More

On August 2, 2016, the Centers for Medicare & Medicaid Services (“CMS”) released its Hospital Inpatient Prospective Payment System and Long-Term Acute Care Hospital Final Rule Issues for Fiscal Year 2017, which are set to be published on August 22, 2016 and effective October 1, 2016. CMS included the final rule for Hospital Notification Procedures…Read More

CMS has issued the final Inpatient Prospective Payment System (“IPPS”) rule for FFY 2017, restoring payments CMS has taken away from hospitals since FFY 2014, which relates to implementation of the Two-Midnight Rule that redefined the definition of inpatient admissions. Not only will there be no 0.2 percent decrease in IPPS payments in FFY 2017, but CMS…Read More

This is the third article in a series discussing the Department of Health and Human Services (“HHS”) Office of Civil Rights (“OCR”) final rule (“Final Rule”) implementing Section 1557 of the Patient Protection and Affordable Care Act (“ACA”). Failure to comply with the Final Rule can result in the loss of federal funding, and individuals…Read More