Articles and Blogs

On May 17, 2019, CMS released the preliminary FY 2021 Worksheet S-3, Parts II and III wage index Public Use File (“PUF”). The PUF contains wage data based on FFY 2017 hospital cost reports – that is, cost reports with fiscal year begin dates of on or after October 1, 2016 and on or before September 30, 2017. The... READ MORE

In November 2018, the Government Accountability Office (“GAO”) released a report (“Report”) on new laboratory payment rates established by CMS under the Protecting Access to Medicare Act (“PAMA”). In the Report, the GAO analyzed Medicare claims data to assess how CMS’s implementation of these new rates will impact Medicare expenditures and recommended CMS take... READ MORE

The DOJ’s recent revisions to its Justice Manual created a new path for self-disclosing potential fraud to the government – one which is unique in its ability to defray the costs of potential False Claims Act violations. In 2015, Deputy Attorney General Sally Quillian Yates released a memo entitled Individual Accountability for Corporate Wrongdoing, more... READ MORE

This is the first in a series of articles discussing the countdown to Phase 3 skilled nursing home compliance programs. To view other articles in this series, click here. Beginning on November 28, 2019, surveyors will use the requirements detailed 42 C.F.R. Section 483.85, the Requirements for States and Long-Term Care Facilities (“Final Regulations”)... READ MORE

The Centers for Medicare & Medicaid Services (“CMS”) recently published a final rule (“Final Rule”) revising the procedures that CMS uses to administer its Preclusion List. As outlined below, CMS now requires Medicare Advantage, Medicare Part D and other designated plans to deny payment for items or services provided by or prescribed by a... READ MORE

On April 22, 2019, the Centers for Medicare & Medicaid Services (“CMS”) announced a new set of value-based payment models for reimbursement of primary care services. CMS has coined the new models its “Primary Cares Initiative.” Although participation in the models is currently voluntary, CMS hopes the initiative will accelerate the nationwide transition of... READ MORE

In keeping with the trends of the commercial market, on April 22, 2019, the Centers for Medicare & Medicaid Services (“CMS”) announced opportunities to participate in new direct contracting models under Medicare’s Part A and Part B fee-for-service program. CMS intends to focus these models particularly on primary care coordination for medically complex and... READ MORE

On May 6, 2019, the United States District Court in Washington, D.C. issued its opinion on the appropriate remedy to address the invalidated payment cuts set forth in the 2018 and 2019 Outpatient Prospective Payment System final rules (“2018 and 2019 OPPS Rules”) for drugs purchased under the 340B drug discount program (“340B Program”).... READ MORE

On May 3, 2019, CMS released its long-awaited guidance on hospital co-location and shared service arrangements in the form of a draft survey memo (“Memo”), which is available here. The Memo clarifies how a hospital can co-locate with other health care entities without violating the Medicare Conditions of Participation (“CoPs”). CMS has been promising... READ MORE

Health Cost Reduction Package Slated for Summer Release Speaking on the Senate floor on Thursday, Sen. Lamar Alexander (R-TN), Chairman of the Health, Education, Labor, and Pensions (“HELP”) Committee, said he plans to move a wide-ranging legislative package through his panel seeking to curb health care costs. Sen. Alexander, along with HELP ranking member... READ MORE