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Introduction to the Patient Protection and Affordable Care Act (PPACA) and the Health Care and Education Reconciliation Act of 2010

By Timothy S. Jost, Robert L. Willett Family Professor of Law, Washington and Lee University School of Law The health care reform legislation adopted by Congress consists of the (originally) 2409 page Senate "Patient Protection and Affordable Care Act," (PPACA), signed into law by President...

Pre- and Post-Commencement of an Investigation of Health Care Compliance: Key Considerations for all Providers

By Gretchen Heinze Townshend and Elizabeth Bedore Campbell, Attorneys at Law Five health care fraud settlements in excess of $100 million were reported last year, with total recoveries from health care providers amounting to $2 billion. Providers need to understand that in today's regulatory...

Spotlight on Health Care Reform Resource Center

Welcome! We've designed this resource center to help you locate materials on health care reform, here on the LexisNexis Emerging Issues Law Community, the Internet, and lexis.com. Please be sure to check back often for new updates to the Spotlight on Health Care Reform Resource Center. ...

State Net Capitol Journal: Health Care Reform Law Doesn't Halt Major Rate Hikes

One of the main objectives of the Affordable Care Act was to stem the rising cost of health insurance for American consumers. But that hasn't stopped health insurance companies from seeking and obtaining big premium increases across the country. In Florida and Ohio, insurers have secured rate increases...

Williams Mullen Health Care Fraud and Abuse Alert: What CMS’s New Billing Requirement For ‘Incident To” Services Means For Medicare Providers

By Brian C. Vick In the final Medicare Physician Fee Schedule for 2014 (“2014 PFS”), CMS implemented a new condition of payment for “incident to” services that has significant fraud and abuse implications for any Medicare provider who relies on reimbursement revenue from these...

Norton Rose Fulbright: OIG Releases FY 2014Work Plan Summary

By Frederick Robinson , Megan Fanale Engel , Cori Annapolen Goldberg and Selina Coleman On January 31, 2014, the U.S. Department of Health and Human Services Office of Inspector General (OIG) published its Work Plan for fiscal year 2014. The OIG announced that in the upcoming year, it will continue...

Williams Mullen: OIG Scrutiny of Hospital Outpatient Evaluation/Management Claims Billed to Medicare

By Marcus C. Hewitt H.H.S’s Office of Inspector General’s yearly work plan was issued on January 31, 2014, which included numerous new and ongoing reviews and activities by OIG for the coming year. Among the new projects, OIG will review Medicare payments to hospitals for outpatient evaluation...

Williams Mullen: OIG 2014 Work Plan Focuses On Compounded Pharmaceuticals Reimbursed By Medicare

By Brian C. Vick The Office of Inspector General for the U.S. Department of Health and Human Services (“OIG”) included two items in its recently-released 2014 Work Plan indicating a new focus on the quality and safety of compounded pharmaceuticals reimbursed by Medicare. Pharmaceutical...

Barnes & Thornburg LLP: OIG Work Plan 2014: Takeaways for Hospitals

By Gayland Hethcoat With the release of its work plan for fiscal year 2014 on Jan. 31, 2013, the U.S. Department of Health and Human Services (HHS) Office of the Inspector General (OIG) has provided insight on the agency’s current enforcement priorities in Medicare, Medicaid, and other HHS programs...

Norton Rose Fulbright: CMS Offers New Resources and Guidance on 2-Phase Approach to Sunshine Act Reporting

By: Benjamin Koplin , Selina Coleman and R. Jeffrey Layne The Centers for Medicare & Medicaid Services (CMS) has posted new resources to its "Open Payments" website to clarify its recently announced two-stage approach to registration and data submission. These resources include: ...

Barnes & Thornburg LLP: President Obama Signs Bill Extending Physician Medicare Rates And Delaying ICD-10 And RAC Audits Under The 2-Midnights Rule

By Nita Garg On April 1, President Obama signed the Protecting Access to Medicare Act of 2014. This legislation extends current Medicare physician reimbursement rates and delays implementation of the ICD-10 code for a full year. Previously, hospitals were to be ICD-10 compliant by October 1, 2014;...

Steptoe & Johnson PLLC: False Billing Leads To Record Settlement In Medicare/Medicaid Fraud Case

The United States Attorney for the Southern District of West Virginia has announced a record $4.675 million settlement with a medical lab for false billings to Medicare and to West Virginia Medicaid. R. Booth Goodwin, of Charleston, WV, said in his press release that Calloway Laboratories of Woburn,...

Williams Mullen: CMS Proposes Rule That Would Expand Its Authority To Audit Medicare Advantage Plans

By Brian C. Vick O n April 30, 2014, the Centers for Medicare and Medicaid Services (“CMS”) issued a proposed rule to update payment policies and rates for inpatient hospitals (the “Proposed Rule”) that includes a provision with significant future implications for sponsors...

Norton Rose Fulbright: Physicians Payments Sunshine Act Data 33 Percent Unpublishable, Penalties Next?

By Benjamin Koplin , Selina Coleman and R. Jeffrey Layne Despite extending the dispute-and-resolution deadline to account for the days that the Centers for Medicare & Medicaid Services (CMS) pulled down the reporting system, the public Physician Payments Sunshine Act website is still expected...

Norton Rose Fulbright: CMS Offers Settlement Of Inpatient RAC Denials

By Mark Faccenda On August 29, 2014, the Centers for Medicare and Medicaid Services (“ CMS ”) announced that certain providers with pending appeals of specified inpatient-status claims denied by Medicare contractors may elect to receive partial payment on those claims in exchange for the...

DLA Piper Health Systems Alert: MACRA: 3 Compliance Implications For Medicare Providers

By: Karen Nelson Much has been written about the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and its repeal of the Sustainable Growth Rate formula for physician compensation and the potential gainsharing safe harbor. But the Act also includes certain Medicare program integrity provisions...

Barnes & Thornburg: CMS Releases Physician-Level Payment Data Totaling More Than $90 Billion in Medicare Reimbursements for 2013

By Jessica Talati On June 1, the Centers for Medicare & Medicaid Services (CMS) released its second annual installment of Medicare reimbursement data for physicians and other practitioners. The data set contains records for more than 950,000 practitioners who received a collective $90 billion...

Steptoe & Johnson PLLC: Under Stark, ‘Value’ Doesn’t Mean ‘Expensive’

The federal Stark law prohibits physician referrals of “designated health services” payable by Medicare to entities with which the physician or an immediate family member has a financial relationship, unless the arrangement meets an exception. Enforcement initiatives aim at extending the...

Williams Mullen: Affirming the Need to Fix the Medicare Appeals Backlog: The AFIRM Act of 2015

By: Kelsey S. Farbotko If you are one of the many health care providers wanting to appeal a Medicare contractor’s reimbursement decision, you may need to be prepared for a long wait. Over the last few years, the backlog of appeals to the administrative hearing level has grown into an untenable...