On January 22, 2015, in the case of Barrows v. Burwell, No. 3:11-cv-1703, 2015 WL 264727 (2nd Cir., January 22, 2015), the United States Court of Appeals for the Second Circuit ruled that Medicare beneficiaries be granted the opportunity to demonstrate a Constitutionally-protected property interest to challenge their patient status designations as hospital outpatients rather […]
Health care providers across the country are still adapting to the unprecedented disclosure of health care information that is associated with the government’s effort create a more transparent health care system. As many providers recall, in April, 2014, the Centers for Medicare & Medicaid Services (“CMS”), which administers the Medicare program, publicly released detailed data […]
The government recently took the unusual step of filing an amicus brief in a civil case involving Stark Law and Anti-Kickback Statute (“AKS“) issues. See, Ameritox, Ltd. v. Millennium Laboratories, Inc., Case No. 14-14281 (U.S. Court of Appeals for the 11th Circuit). The amicus brief provides insight into – and clarification of – the government’s […]
On January 20, 2015, the Food and Drug Administration (“FDA”) published two draft guidance documents that revealed its way of thinking on the regulation of low risk general wellness products and regulation of medical device accessories. Broadly speaking, the proposed guidance indicates that the FDA will not regulate low risk products intended only for general […]
According to a new report from the Office of Inspector General (“OIG”) published on January 13, 2015, the OIG is concerned with the financial incentives created by the current Medicare payment system with regard to hospice beneficiaries in assisted living facilities. For example, hospices received significantly higher Medicare payments for beneficiaries in assisted living facilities […]
The 2015 Home Care Prospective Payment Final Rule (effective January 1, 2015), relaxes the face-to-face encounter regulations as set forth by the Patient Protection and Affordable Care Act (“PPACA”). During an open door forum held on December 16, 2014, CMS announced that it modified documentation requirements “in an effort to simplify the face-to-face encounter regulations, […]
On December 18, 2014, a U.S. District Court judge dismissed a lawsuit the American Hospital Association (“AHA”) filed against the Department of Health and Human Services (“HHS”) seeking HHS to process their administrative appeals in accordance with statutory timelines. In its order, the Court acknowledged that the Office of Medicare Hearings and Appeals (“OMHA”) is […]
The Centers for Medicare and Medicaid Services (“CMS”) is charged with the implementation of the Physician Payments Sunshine Act. CMS developed the Open Payments Program to keep track of data on consulting fees, research grants, travel reimbursements and other gifts made by certain manufacturers and organizations to physicians and teaching hospitals. Since the implementation of […]
On October 31, 2014, the Department of Health and Human Services (“HHS”) Office of the Inspector General (“OIG”) released its Fiscal Year (“FY”) 2015 Work Plan summarizing its new and ongoing investigative, enforcement, and compliance priorities for the upcoming fiscal year. For FY 2014, the OIG reported recoveries of over $4.9 billion, consisting of nearly […]
In a letter dated December 4, 2014, the American Hospital Association (“AHA”) submitted comments in response to the Office of Medicare Hearings and Appeals (“OMHA”) request for information on current and potential initiatives to resolve the current backlog of appeals at the administrative law judge (“ALJ”) level. In its letter, the AHA takes the position […]
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