Articles and Blogs

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

In a troubling split decision issued on March 22, 2016, a three-judge panel of the Sixth Circuit reversed the ruling by the district court for the Southern District of Ohio at Dayton in The Medical Center at Elizabeth Place, LLC v. Atrium Health System, et al. and remanded the case back to the district court…Read More

For nearly 68 years, the general understanding was that in collective bargaining, both sides have access to weapons in the game of economic warfare. Unions and employees have the right to strike, and employers have the right keep the doors open by replacing the striking employees – either temporarily or permanently. There were exceptions of course. Unions and…Read More

A recent whistleblower case could have a significant impact on Medicare Part D charge limits and corresponding reimbursement and could have ripple effects for aspects of other Medicare programs. The Seventh Circuit Court of Appeals ruled that reduced prescription prices offered by a large retail pharmacy (here Kmart) to participants enrolled in a popular discount program…Read More

Releases of FCA claims my only be effective in very limited circumstances, the Second Circuit Court of Appeals ruled in a decision this week. In US ex rel. Ladas v. Exelis, Inc, et al., the court ruled that a pre-filing release is unenforceable as a matter of public policy – the encouragement of qui tam…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 18,…Read More

House Committee Advances Hospital Payment Bill On May 24, the House Ways and Means Committee advanced the Helping Hospitals Improve Patient Care Act (H.R. 5273) that reforms how hospitals are paid for inpatient and outpatient services. The bipartisan bill moves to the House floor where it could be passed by the full House during the week…Read More