On November 8, 2021, the Office of Inspector General (“OIG”) issued multiple updates to the Health Care Fraud Self-Disclosure Protocol (“SDP”), incorporating legal changes made since the previous SDP revision in 2013. The OIG’s updated SDP may be accessed here. Below is an overview of the updates. By way of brief background, the SDP provides […]
Recently, the U.S. Dept. of Health and Human Services (“HHS”), Dept. of Labor, Dept. of Treasury, and the Office of Personal Management jointly issued an interim final rule regarding surprise medical billing. The interim final rule, entitled “Requirements Related to Surprise Billing: Part 1” (the “Rule”) may be accessed here, and will go into effect […]
President Biden recently signed the Act to Prevent Across-the-Board Direct Spending Cuts, and for Other Purposes (the “Act”) (available here) into law. The Act extends the temporary suspension of certain mandatory Medicare FFS claim payment reductions until December 31, 2021. By way of background, the Budget Control Act of 2011 required mandatory across-the-board reductions to […]
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 […]
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 […]
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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