Health Law

Published on: December 18, 2020 | by The Health Law Partners

New CMS Final Rule Provides Medicare Beneficiaries with Greater Surgical Options and Expands Coverage for Certain Surgical Procedures

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 […]

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Published on: November 22, 2020 | by The Health Law Partners

New Michigan Law Prohibits Surprise Medical Billing

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 […]

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Published on: November 12, 2020 | by The Health Law Partners

New York Law Requires Physicians to Immediately Post OPMC Signage

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) […]

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Published on: November 10, 2020 | by The Health Law Partners

Update to New York OMIG and DRA Certification Requirements

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 […]

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Published on: October 28, 2020 | by The Health Law Partners

5th Circuit Ruling Affirms Denial of Injunctive Relief Against Medicare Recoupment during the Administrative Appeals Process

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 […]

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Published on: September 29, 2020 | by The Health Law Partners

HHS and DOJ Issue Health Care Fraud and Abuse Annual Report for FY 2019

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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Published on: September 18, 2020 | by The Health Law Partners

Department of Labor Revises FFCRA Regulations and Redefines “Health Care Provider”

The Department of Labor (DOL) recently issued a temporary rule (the “Revised Rule”) that revised the regulations implementing the Families First Coronavirus Response Act (“FFCRA”). These revisions went into effect on September 16, 2020. By way of background, the FFCRA created two new emergency paid leave requirements, the Emergency Family and Medical Leave Expansion Act […]

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Published on: September 15, 2020 | by The Health Law Partners

An OIG Report Finds Inconsistency by MACs in Reviewing Medicare Extrapolated Overpayments

The U.S. Department of Health and Human Services Office of Inspector General (OIG) has recently issued a report regarding overpayment reviews by Medicare Administrative Contractors (MACs). The OIG’s report determined that MACs have been inconsistent in reviewing extrapolated overpayments during the provider appeals process. These inconsistencies have resulted in at least $42 million in extrapolated […]

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Published on: September 14, 2020 | by The Health Law Partners

Hospitals Brace for Renewed Focus on Total Joint Procedures

On August 3, 2020, two issues were approved for review and posted on the Centers for Medicare & Medicaid Services (CMS) Recovery Audit program website: 0184 – Total Hip Arthroplasty: Medical Necessity and Documentation Requirements, and 0185 – Total Knee Arthroplasty: Medical Necessity and Documentation Requirements. In particular, the approved issues involve whether the documentation […]

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Published on: August 13, 2020 | by The Health Law Partners

The OMHA Expands the Settlement Conference Facilitation ADR Process to Appellants

The Office of Medicare Hearings and Appeals (OMHA) has recently opened the Settlement Conference Facilitation (SCF) to the appellant community. The SCF is an alternative dispute resolution (ADR) process meant to bring certain providers and the Centers for Medicare & Medicaid Services (CMS) together to discuss mutually agreeable resolutions for Medicare Part A and B […]

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