Health Law

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

CMS Issues Proposed Rules for 2021 Medicare Physician Fee Schedule and the Outpatient Prospective Payment System

The Centers for Medicare and Medicaid Services (CMS) has issued two new proposed rules. First, CMS has issued a proposed rule for the 2021 Medicare Physician Fee Schedule (PFS Proposed Rule). The rule will be published on August 17, 2020. You can access the unpublished version here. Second, CMS issued a proposed rule for the […]

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Published on: August 3, 2020 | by The Health Law Partners

SBA Releases Guidance for PPP Loan Forgiveness Applications

Recently, the Small Business Administration (SBA) issued guidance regarding loan forgiveness for the Paycheck Protection Program (PPP). In its guidance, the SBA details the PPP loan forgiveness process and reiterates certain rules and requirements for PPP loan forgiveness. We discussed the PPP loan forgiveness rules and requirements in a prior post, available here. Below is […]

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Published on: June 9, 2020 | by The Health Law Partners

HHS Provider Guidance Regarding Use of Provider Relief Fund Payments and Reporting Requirement

The Department of Health and Human Services (HHS) has issued new FAQs regarding how Provider Relief Fund (PRF) payments may be spent and when recipient-providers must report their use of funds. Under the Terms/Conditions that apply to recipients of PRF funds, each provider is required to have a written policy or written procedures to govern […]

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Published on: June 5, 2020 | by The Health Law Partners

Senate Passes Paycheck Protection Program Reform Bill to Provide Greater Flexibility to Small Businesses

This blog is intended to supplement our prior guidance regarding Paycheck Protection Program (PPP) loan forgiveness, found here. On June 3, 2020, following the House of Representatives’ approval, the U.S. Senate passed bill H.R. 7010 (i.e., the Paycheck Protection Program Flexibility Act of 2020 (the “Bill”)). Subsequently, President Trump signed the Bill into law on […]

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

SBA Issues Rules for Paycheck Protection Program Loan Forgiveness – With Pending Legislation to Afford Borrowers Enhanced Flexibility for Forgiveness

On May 21, 2020, the U.S. Small Business Administration (SBA), in consultation with the Department of Treasury, issued two Interim Final Rules pertaining to loan forgiveness under the Paycheck Protection Program (PPP). The first Interim Final Rule, entitled SBA Loan Review Procedures and Related Borrower and Lender Responsibilities, provides rules regarding procedures for borrowers and […]

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Published on: May 25, 2020 | by The Health Law Partners

For Now, Medicare Beneficiaries Win Right to Challenge Certain Outpatient Observation Placement Orders

On March 24, 2020, the U.S. District Court for the District of Connecticut granted a class of Medicare beneficiaries the right to challenge their designation in hospitals as outpatients receiving observation services rather than as inpatients. In the case, Alexander v. Azar, the court ruled that the Department of Health and Human Services (HHS) violated […]

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Published on: May 25, 2020 | by The Health Law Partners

MI Governor Whitmer Issues Executive Order to Re-Open Healthcare Facilities to Perform Non-Essential Medical and Dental Procedures

On May 21, 2020, Michigan Governor Whitmer issued Executive Order (EO) 2020-96, which permits outpatient healthcare facilities (e.g., primary care physician offices and dental offices) to re-open and perform non-essential medical and dental procedures. EO 2020-96, in part, rescinds prior EO 2020-17 as of May 28, 2020 at 11:59 p.m., which had required physicians and […]

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