Articles and Blogs

On June 26, 2025, the Department of Justice (“DOJ”) announced that a Remote Patient Monitoring (“RPM”) provider (“Company”) and its physician owner, paid $1.29 million to settle allegations of submitting false claims to Medicare under the False Claims Act (“FCA”). This settlement highlights the increased growth in RPM services, while noting the government’s scrutiny... READ MORE

The Centers for Medicare & Medicaid Services (“CMS”) recently issued its calendar year (“CY”) 2026 Outpatient Prospective Payment System (“OPPS”) proposed rule (“Proposed Rule”). The following summarizes several major proposals of the Proposed Rule, and the corresponding fact sheet can be found here. For interested parties and stakeholders, comments should be submitted by September... READ MORE

On April 30, 2025, the Centers for Medicare & Medicaid Services (“CMS”) released the FFY 2026 Inpatient Prospective Payment System (“IPPS”) Proposed Rule (“Proposed Rule”) to update IPPS payment rates, change DSH payments, increase uncompensated care payments and request input on ways to streamline Medicare regulations and reduce provider burden. Increase to Payment Rates... READ MORE

As the NCAA March Madness tournaments heat up, lawmakers and the Trump administration are making their own plays on key federal telehealth policy issues. On March 15, the President signed the Full-Year Continuing Appropriations and Extensions Act, 2025 (“Continuing Resolution”) to fund the federal government through September 30. The Continuing Resolution extends several key... READ MORE

As of February 14, 2025, hospitals[1] will be required to provide notice to patients who are admitted as inpatients but who are later reclassified as outpatients receiving observation services (referred to as “change in patient status”). These patients who receive a change in patient status may request an expedited determination from the Centers for... READ MORE

CMS recently issued a final rule to require health care payers to improve communications between the payers, providers and patients and to improve the prior authorization processes (“Final Rule”). The Final Rule aims to improve electronic exchange of health care data with a particular focus on improving the prior authorization process through the implementation... READ MORE

Starting on August 1, 2023, Medicare validation edits will be activated to require service location addresses on the UB-04 hospital claim form to match exactly with the service location enrolled in Medicare’s Provider Enrollment, Chain, and Ownership System (“PECOS”). Background In a previous article, we reported on the Center for Medicare & Medicaid Services... READ MORE

Over the last 12 months, the Centers for Medicare & Medicaid Services (“CMS”) has received many reports of hospice fraud. In addition, CMS has seen the number of enrolled hospices increase significantly in Arizona, California, Nevada and Texas, raising concerns about market oversaturation.  On July 12, 2023, CMS released a Medicare Learning Network article (the “CMS Oversight Policy”)... READ MORE

On June 8, 2023, the Centers for Medicare & Medicaid Services (“CMS”) announced the Making Care Primary Model (“Model”), a new multi-payor, voluntary primary care model tested by the Center for Medicare and Medicaid Innovation (“CMMI”) and aimed at strengthening the primary care infrastructure for Medicare and Medicaid patients. The Model focuses on primary... READ MORE

The Centers for Medicare & Medicaid Services (“CMS”) is now accepting applications from ACOs to participate in the Medicare Shared Savings Program (“MSSP” or “Program”) for the agreement period beginning January 1, 2024. The application process is split into two phases. Phase 1 of the application submission process opened May 18, 2023, and closes... READ MORE