CMS Applies the Brakes to Mandatory Bundled Payment Models: Proposed Rule to Revise the Comprehensive Care for Joint Replacement Model and Cancel the Episode Payment Models and Cardiac Rehabilitation Payment Model

The Centers for Medicare & Medicaid Services (CMS) published a proposed rule on Thursday, August 17, 2017 (Proposed Rule)1 that, if adopted without significant change, will cancel three bundled payment models and a post-cardiac episode incentive model before their launch, and shrink the scope of another bundled payment model as it approaches its third year in […]

Over 240 Arrests By The FBI For Largest Medicare Fraud Bust In History

On June 18, 2015, Attorney General Loretta E. Lynch and Department of Health and Human Services (“HHS”) Secretary Sylvia Mathews Burwell, accompanied by FBI Director James B. Comey and members of the Department of Justice (“DOJ”), announced the largest Medicare fraud bust in history. This bust ended with 243 individuals, including 46 licensed medical professionals, being arrested […]

DOJ Announces Record Settlement

On June 16, 2015, the Department of Justice (“DOJ”) announced a record-setting $17 million settlement with a Florida skilled nursing facility over allegations that the facility violated the Antikickback Statute (“AKS”) and False Claims Act (“FCA”).  The AKS (42 U.S.C. § 1320a-7b), a criminal statute with significant civil money penalties attached,  prohibits the exchange of anything of […]

The Controversial “Two-Midnight” Rule: Where We’ve Been And What To Expect When Implementation Begins Later This Year

On April 16, 2015, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was signed into law. Among other functions,1 MACRA further delayed the implementation of the much-anticipated provisions of the 2014 Inpatient Prospective Payment System Final Rule affecting reviews of inpatient admissions, including new guidelines for inpatient admissions known as the “two-midnight” rule, until […]

CMS Updates On Hospice Election Form, Revocation, And Designation Of Attending Physician

On April 3, 2015, the Center for Medicare & Medicaid Services (“CMS”) issued Change Request 9114 to Medicare Administrative Contractors (“MACs”) implementing the changes finalized in the FY 2015 hospice rule regarding election, revocation, and designation of an attending physician. These changes are effective May 5, 2015. Background Upon electing hospice care, a beneficiary waives […]

Medicare “Probe and Educate” Period Extended Through April 30, 2015

The Centers for Medicare & Medicaid Services (“CMS”) recently announced that the Medicare Inpatient “probe and educate” period will be extended through April 30, 2015. Prior to this announcement, the Probe and Educate period was set to expire on March 31, 2015. As brief background, the “probe and educate” period was a CMS effort hoped […]

CMS Issues Stage 3 Meaningful Use Proposed Rule

On March 30, 2015, the Department of Health and Human Services’ Centers for Medicare & Medicaid Services (“CMS”) published a 73-page proposed rule for Stage 3 Meaningful Use (available here), addressing criteria that eligible professionals (“EPs”), eligible hospitals, and critical access hospitals (“CAHs”) must meet in order to receive incentive payments and avoid payment reduction […]

Dissection of the Final Regulations Under PPACA (IRC 501(R)) For 501(C)(3) Hospitals

The Internal Revenue Service and Department of Treasury recently issued final regulations under Section 501(r) of the Internal Revenue Code (Final Regulations). Section 501(r), added as part of the Patient Protection and Affordable Care Act of 2010 (PPACA), established additional requirements for hospitals exempt from federal income taxation under IRC 501(c)(3) – most notably periodic […]

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