On Thursday, August 2, 2018, the Centers for Medicare & Medicaid Services (“CMS”) released its 2019 Inpatient Prospective Payment System and Long-Term Care Hospital Prospective Payment System Final Rule (the “2019 IPPS Final Rule”).[1] With the goal to reduce unnecessary administrative burden on physicians and other qualified practitioners, the 2019 IPPS Final Rule revises the […]
The National Guideline Clearinghouse (NGC) website, “guideline.gov,” compiles the latest information on medical treatment for use by healthcare organizations, physicians, bulk purchasers, educational institutions, and state and local governments, while also providing guidance on medications and procedures ranging from miniscule to critical. The NGC contains over 20 years of evidence-based clinical practices and medical guidelines, […]
July 2018- Section 1877 of the Social Security Act, widely known as the physician self-referral law, prohibits a physician from making service referrals payable by Medicare to entities that they may have a financial relationship with. Section 50404 of the Bipartisan Budget Act (“BBA”) of 2018 added provisions to section 1877(h)(1) of the Social Security […]
July 2018 – On July 12, 2018, the Centers for Medicare & Medicaid Services (“CMS”) proposed rules aimed at fundamentally improving the nation’s healthcare system and restoring the doctor-patient relationship. The proposal is “one of the most significant reductions in provider burden undertaken by any administration,” according to CMS director Seema Verma. The new proposed […]
June 2018 – On June 19, 2018, the Centers for Medicare & Medicaid Services (“CMS”) issued a Request for Information (“RFI”) seeking public input on how to address any undue impact and burden of the physician self-referral law, 42 U.S.C. § 1395nn (the “Stark Law”). By way of background, the Stark Law addresses the concern […]
Please Join The HLP at the 2018 Physicians Legal Issues Conference in Chicago, Illinois The Health Law Partners (HLP) is proud to be part of the upcoming Physician Legal Issues Conference co-sponsored by the American Bar Association Health Law Section and Chicago Medical Society. The conference will take place at the Intercontinental Hotel in Chicago […]
March 2018 – Recent additions to the Medicare Shared Savings Program (“MSSP”), include several changes aimed to encourage Medicare beneficiaries to take a more proactive approach with their health care. By way of background, on March 23, 2010, Section 3022 of the Affordable Care Act added section 1899 (42 U.S.C. § 1395jjj) to the Social […]
In the world of litigation healthcare providers can potentially fall victim to the False Claims Act (“FCA”) when they file medical claims for reimbursement from either Medicaid or Medicare. FCA claims against hospitals and other healthcare related entities usually involve allegations that the healthcare provider knowingly or recklessly filed a false claim for payment from […]
In its recent Advisory Opinion No. 17-05, OIG stated that the Proposed Arrangement (“Arrangement”) would not violate the anti-kickback statute (“AKS”) nor would it prompt administrative sanctions under the Civil Monetary Penalties (“CMP”) provision of the Social Security Act, prohibiting inducements to beneficiaries. The Proposed Arrangement discussed in the Opinion centers around a retail pharmacy […]
Home Health Agencies will now have an additional 6 months to comply with a new CMS rule intended to advance the quality of patient care. CMS published a final rule on July 10th delaying the effective date for its rule addressing conditions of participation for home health agencies. CMS has moved the effective date of […]
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