Articles and Blogs

Recently, the Department of Health and Human Services Office of the Inspector General (“OIG”) and the Department of Justice (“DOJ”) released the FY 2015 Health Care Fraud and Abuse Control Program Annual Report (“Annual Report”). The Annual Report details the enforcement actions and the monetary gains from efforts by the OIG and DOJ to fight…Read More

On June 16, 2016, the United States Supreme Court issued its decision in Universal Health Services, Inc. v. United States ex rel. Escobar, a False Claims Act (“FCA”) case reviewing the theory of implied certification, which was subject to a circuit court split. In the opinion, the Court upheld the viability of the implied certification…Read More

On January 1, 2016, the new Stark Law “timeshare license” exception became law. We reported on the proposed rule here and the final rule here. Initially, the exception received somewhat mixed reviews, which resulted in some hesitancy to employ it. Now that the dust has settled, we believe that the exception presents significant advantages over…Read More

CMS Issues Proposed Rule Updating Conditions of Participation for Hospitals On June 13, CMS released a proposed rule amending the conditions that hospitals and critical access hospitals (“CAHs”) must meet to be eligible to participate in the Medicare and Medicaid programs. The agency’s proposal, which includes comprehensive requirements to reduce infections, curb the overuse of…Read More

The U.S. Supreme Court issued its decision today in Universal Health Services, Inc. v. United States ex rel. Escobar, and it will have an enormous effect on False Claims Act (“FCA”) cases throughout the nation. In Escobar, the FCA case was based upon the theory that counseling was provided by practitioners who were not properly licensed…Read More

On May 13, 2016, the Office of Civil Rights (“OCR”) of the Department of Health and Human Services (“HHS”) issued a final rule (“Final Rule”) implementing Section 1557 of the Patient Protection and Affordable Care Act (“ACA”). A copy of the Final Rule is available here. The rule is scheduled to become effective on July…Read More

On June 10, 2016, CMS released a final rule regarding the Medicare Shared Savings Program (“MSSP”).  The rule modifies MSSP’s benchmarking methodology, including, for MSSP ACOs commencing their second or subsequent agreement period in 2017 or thereafter, the use of regional factors in resetting benchmarks.  The rule also provides a new option for MSSP ACOs…Read More

House Passes Bill that Includes Provision to Revise HOPD Site-Neutral Payment Policy On June 7, the House of Representatives passed the Helping Hospitals Improve Patient Care Act of 2016 (H.R. 5273) that would modify payment policies under Medicare for certain hospital outpatient departments and some hospital inpatient services. The bill would also change meaningful use…Read More

On June 3, 2016, CMS released a memorandum that answered questions regarding the agency’s criteria for selection of enforcement remedies for long-term care facilities with deficiencies. The document reported data on enforcement actions taken by the agency when a nursing home is not in compliance with the Medicare and Medicaid requirements of 42 C.F.R. Part…Read More

OIG Releases Report on Health Care Fraud and Abuse On May 31, the HHS Office of Inspector General (“OIG”) issued its Semiannual Report to Congress outlining the agency’s operations during the first half of fiscal year 2016. According to the report, OIG recovered $2.77 billion in improper payments, including $554.7 million from audits and $2.2 billion…Read More