Articles and Blogs

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

Could it be that CMS is implementing changes in the Medicare Communications and Marketing standards that will change the content and tone of the omnipresent television and radio advertisements targeted at potential enrollees? On the heels of publishing a final rule modifying the regulations for Medicare communications and marketing in April, on May 10,... READ MORE

March 17, 2023, was the transition period deadline for full state compliance with the Home and Community-Based Services (“HCBS”) Final Regulation.  As part of the steps to get ready for this deadline, in late 2022, the Centers for Medicare & Medicaid Services (“CMS”) visited several settings in multiple states that were identified by the... READ MORE

On February 7, 2023, the Department of Justice (“DOJ”) announced that it recovered over $2.2 billion in False Claims Act (“FCA”) related settlements and judgments in the federal fiscal year 2022. While this is less than half of the previous year’s recovery of $5.6 billion, the number of cases settled was the second highest... READ MORE

Medicare payment policy changes established under the CMS CY 2023 Medicare Physician Fee Schedule (“MPFS”) Final Rule, issued on November 1, 2022, become effective January 1, 2023. Below is a high-level summary of significant changes established for 2023. Evaluation and Management (E/M) Visits Over the past several years, CMS engaged in efforts with the... READ MORE

In December 2021, the Office of Inspector General (“OIG”) of the Department of Health and Human Services published an Issue Brief titled “Medicare and Beneficiaries Pay More for Preadmission Services at Affiliated Hospitals Than Wholly Owned Settings” (“Brief”)(available here). The Brief discusses Medicare’s policy to bundle (or not separately pay) certain services provided by... READ MORE

In a new report, the Department of Health and Human Services Office of Inspector General (“OIG”) concluded that hospitals are increasingly billing Medicare for inpatient stays at the highest, most expensive severity level despite many of these stays having only one qualifying diagnosis for payment at the highest severity level and others lasting only... READ MORE

On May 11, 2020, the Centers for Medicare & Medicaid Services (“CMS”) released the 2021 Inpatient Prospective Payment System (“IPPS”) Proposed Rule (“Proposed Rule”). One of the most significant updates is the proposed addition of a new requirement to the Medicare cost report submission process. Specifically, hospitals would be required to provide the median... READ MORE