On January 15, 2021, the Department of Health and Human Services (“HHS”) issued updated guidance on reporting requirements related to use of Provider Relief Fund (“PRF”) monies.  HHS will be issuing further updates, which will impact how providers are required to report and whether providers will be allowed to retain all of the PRF monies […]

The Centers for Medicaid & Medicare Services (CMS) recently released the 2021 Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Final Rule, which may be accessed here. Significantly, the Final Rule contains policy changes by CMS that are intended to provide Medicare patients and their physicians greater choices in the outpatient setting at […]

The Centers for Medicaid & Medicare Services (CMS) recently released the 2021 Physician Fee Schedule (PFS) Final Rule. The PFS Final Rule is scheduled to be published on December 28, 2020, but an unpublished version may be accessed here. CMS has also issued a fact sheet, which overviews the changes made by the 2021 PFS […]

On November 20, 2020, in a joint effort, the Department of Health and Human Services (“HHS”) Office of Inspector General (“OIG”) and the Centers for Medicare & Medicaid Services (“CMS”) issued final rules to revise and modernize the Physician Self-Referral Law (“Stark Law”), Anti-Kickback Statute (“AKS”) and Civil Monetary Penalties Law (“CMP”). CMS’ final rule […]

Michigan recently enacted legislation intended to protect consumers from surprise medical billing. The legislation amends Michigan’s public health code (PHC) by adding Article 18, which establishes disclosure requirements and limitations on payments for out-of-network providers (i.e., providers that do not participate in a patient’s health benefit plan) in certain circumstances. The law was enacted primarily […]

This blog serves as an update to our previous blog, entitled “Update to New York OMIG and DRA Certification Requirements,” posted on November 10, 2020. The previous blog may be accessed here. By way of brief background, the New York State Department of Health (NYSDOH) announced in its October 2020 Medicaid Update (available here) that […]

On October 7, 2020, New York Governor Cuomo signed into law a new requirement that “all physicians’ practice settings” must post conspicuous signage directing patients to the New York Office for Professional Medical Conduct’s (OPMC) website for information about patient rights and reporting professional misconduct. In particular, New York Public Health Law Sec. 230 (11) […]

The New York State Department of Health (NYSDOH), in its October 2020 Medicaid Update (published last week on November 2, 2020), announced that the annual December certifications (i.e., the Office of the Medicaid Inspector General (OMIG) and Deficit Reduction Act (DRA) certifications (commonly referred to as the SSL Certification and DRA Certification, respectively)) required by […]

On September 18th, a panel of the Fifth Circuit affirmed a lower court ruling denying injunctive relief against recoupment for Medicare providers still faced with an overpayment demand after going through the first two steps of the administrative review process. In affirming the lower court’s decision, the Fifth Circuit affirmed that the government had provided […]

The Department of Health and Human Services (“HHS”) and the Department of Justice (“DOJ”) recently released the Health Care Fraud and Abuse Control Program Annual Report for 2019 (the “Report”). The Report provides an overview of the joint effort of the HHS and DOJ in identifying and prosecuting health care fraud in Fiscal Year 2019. […]

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