Articles and Blogs

CMS Releases Core Measure Sets On February 16, CMS and America’s Health Insurance Plans (“AHIP”) released seven sets of clinical quality measures as part of the Core Quality Measures Collaborative (“Collaborative”) of health care system participants. The guiding principles used by the Collaborative in creating the measure sets are that they be meaningful to consumers,…Read More

The Department of Health and Human Services Office of Inspector General (“OIG”) recently issued Advisory Opinions 15-16 and 15-17 approving two financial assistance programs offered by nonprofit, tax-exempt, charitable organizations. Based on the structure of each program, OIG concluded that the arrangements would not constitute grounds for the imposition of civil monetary penalties or result…Read More

In 2010, the False Claims Act (“FCA”) was extensively amended to limit the public disclosure bar and to expand the ability of whistleblowers to qualify as “original sources” in qui tam litigation. This month, the Fourth Circuit Court of Appeals took an in-depth look at both provisions, in the case US ex rel. Moore & Co. v…Read More

West Virginia joins 25 other states that have adopted “right to work” laws that prohibit private employers from requiring workers to pay union dues, fees and assessments as a condition of employment. Governor Earl Ray Tomblin (D) initially vetoed the measure, but on February 12, 2016, the West Virginia legislature overrode the governor’s veto. The…Read More

Executive Summary On February 11, 2016, the Centers for Medicare & Medicaid Services (“CMS”) issued its long-awaited Final Rule (“Final Rule”) implementing the overpayment reporting and repayment provisions of the Patient Protection and Affordable Care Act (“PPACA”). The Final Rule clarifies certain provisions set out in the February 14, 2012 Proposed Rule (“Proposed Rule”), modifies…Read More

Obama Releases FY 2017 Budget On February 9, President Obama released a $4.1 trillion budget outlining spending proposals and priorities for fiscal year 2017. Nearly one-fourth of the budget is allocated to CMS for the agency’s entitlement programs. The proposal also provides $82.8 billion in discretionary funding for HHS and makes mandatory investment in programs…Read More

On February 11, 2016, the Equal Employment Opportunity Office (“EEOC”) released its data for charges and claims litigated in 2015. Below are the highlights. A total of 89,385 workplace discrimination charges were received. More retaliation charges were received than any other type of claim enforced by the EEOC. Retaliation charges constituted almost 45 percent of the total number of…Read More

This week, the Centers for Medicare & Medicaid Services (“CMS”) announced that the attestation deadline for the Medicare Electronic Health Record Incentive Program (“Meaningful Use Program”) is changed from February 29, 2016 to March 11, 2016. The new deadline applies to all eligible professionals, eligible hospitals and critical access hospitals participating in the Meaningful Use…Read More

CMS has released its final 60-Day Overpayment Rule, providing clarity to the 2010 Affordable Care Act (“ACA”) amendment to the False Claims Act (“FCA”) that created FCA liability for failure to repay identified overpayment within 60 days. This is a long-awaited rule that provides essential clarity to an amendment that, until now, has vastly expanded…Read More

Some court decisions are so marvelous, so great at cutting through all the legal argument and theoretical absurdity, that they deserve to be quoted at length. On February 4, 2016, the Hon. Raymond M. Kethledge of the Sixth Circuit Court of Appeals wrote just such an opinion. What follows is the first paragraph of that opinion in…Read More