Publications

On July 13, 2017, CMS issued the 2018 Proposed Rules governing the outpatient prospective payment system and ambulatory surgery prospective payment system.  The Proposed Rules include a number of proposed policy changes which are subject to comment until September 11, 2017.  A final rule is expected to be published on […]

Whenever a hospital medical staff makes a decision that adversely affects a member’s privileges, it needs to determine whether to report the decision to the National Practitioner Data Bank (“NPDB”).  Those decisions can be surprisingly complex, as a recent Federal case highlights, and may depend on the wording of the […]

This is the second of a three-part overview of the new partnership audit rules codified in the Bipartisan Budget Act of 2015 (the “Act”) that will take effect January 1, 2018.  In Part 1, we provided an overview of the new partnership audit rules. In this Part, we describe the […]

In an effort to reflect a more “dynamic” work planning process, the OIG recently announced that, effective June 15, 2017, it went beyond its mid-year update by adding monthly updates to the annual Work Plan which are posted on the OIG’s website. See https://oig.hhs.gov/reports-and-publications/workplan/index.asp The OIG’s Work Plan is comprehensive […]

A recent Eleventh Circuit Court of Appeals decision opens the door to a broader view of False Claims Act (“FCA”) liability. The Court’s decision in U.S. ex rel. Phalp v Lincare Holdings, Inc., issued in May 2017, looked more deeply into a Medicare supplier’s subjective state of mind than is […]