CMS’s annual report demonstrates that the government is becoming increasingly effective at ferreting out fraud and abuse from the healthcare system. With a 12-to-1 return on investment, the government will likely continue to make fighting healthcare fraud a priority.
Senate advances comprehensive opioid bill for President to sign
On July 13, 2016, the Senate passed by 92-2 vote the Comprehensive Addiction and Recovery Act of 2016 (S. 524), a comprehensive set of 18 bills targeting the opioid crisis, which bill the U.S. House of Representatives approved in a 407-5 vote on July 8, 2016.
Your money or your PHI: New guidance on ransomware
On June 12, 2016, the HHS Office of Civil Rights (OCR) released guidance, entitled “FACT SHEET: Ransomware and HIPAA,” in response to the rising number of ransomware attacks perpetrated against healthcare entities. The guidance addresses Health Insurance Portability and Accountability Act (HIPAA) issues that may arise when medical records containing Protected Health Information (PHI) are compromised or stolen during a ransomware attack. OCR’s view is that compliance with HIPAA’s information security requirements assists healthcare entities in preventing and recovering from ransomware attacks.
Texas supreme court temporarily halts state Medicaid cuts for home health therapy programs for disabled children
The Texas Supreme Court has temporarily blocked the Texas Health and Human Services Commission’s planned rate reductions for Medicaid home health services for severely disabled children, holding that a temporary injunction issued by a trial court enjoining the rate cuts from taking effect remains binding pending the issuance of a mandate by the Texas Third Court of Appeals reversing the trial court decision or further review by the Texas Supreme Court.
CY 2017 OPPS Proposed Rule sets new off-campus HOPD requirements
On July 6, 2016, CMS published its Calendar Year (CY) 2017 Outpatient Prospective Payment System (OPPS) Proposed Rule. We provide a more detailed analysis of the significant proposals to our July 6 post below.
CMS 2017 OPPS Proposed Rule includes Medicare payment provisions for hospital off-campus outpatient departments
On July 6, 2016, the Centers for Medicare & Medicaid Services (CMS) published its Calendar Year (CY) 2017 Outpatient Prospective Payment System Proposed Rule. We will be providing an in-depth analysis of all significant proposals shortly. In the interim, we
2015 CMS “Open Payments” data released
Last week, CMS posted the 2015 Open Payments data to its website, as well as updated payment records for 2013 and 2014. Overall, manufacturers reported $7.52 billion in payments and ownership interests to 618,931 physicians and 1,116 teaching hospitals in 2015. Nearly 1,500 companies reported making payments in 2015, comprising a total 11.9 million records. Although the total number of records and amounts of payment are comparable from 2014 to 2015, there are shifts in the reporting of the nature of payments.
Legal Update: DOJ announces near doubling of FCA penalties
The DOJ has confirmed that the amount of False Claims Act civil penalties is set to nearly double following recent updates to FCA regulations.
OIG finds ED drug-discount program would not trigger kickback sanctions
On June 27, 2016, the OIG posted Advisory Opinion No. 16-07 stating that an erectile dysfunction (ED) drug manufacturer would not face sanctions for a planned discount-card promotion for the drug.