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Jul 25, 2024 | 
jdsupra.com | Albert W. Shay |Howard Young
The Centers for Medicare & Medicaid Services has issued its Calendar Year 2025 Medicare Physician Fee Schedule Proposed Rule, scheduled for publication in the Federal Register on July 31, 2024. In response to industry concerns from previous comment periods, the proposed rule adds further revisions to the so-called 60-Day Rule, including formally establishing a six-month period to investigate and calculate overpayments.
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Jul 24, 2024 | 
morganlewis.com | Albert W. Shay |Howard Young
The Centers for Medicare & Medicaid Services has issued its Calendar Year 2025 Medicare Physician Fee Schedule Proposed Rule, scheduled for publication in the Federal Register on July 31, 2024. In response to industry concerns from previous comment periods, the proposed rule adds further revisions to the so-called 60-Day Rule, including formally establishing a six-month period to investigate and calculate overpayments.
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Jan 19, 2024 | 
jdsupra.com | Felicia Alexander |B. Scott McBride |Albert W. Shay
The US Department of Health and Human Services Office of Inspector General (OIG) published favorable Advisory Opinion No. 23-15 on January 3, which concluded that a consultant’s proposal to provide gift cards to existing physician practice customers in exchange for referring other physician practices to the vendor would not implicate the federal Anti-Kickback Statute (AKS).
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Jan 18, 2024 | 
morganlewis.com | B. Scott McBride |Albert W. Shay |Felicia Alexander
The US Department of Health and Human Services Office of Inspector General (OIG) published favorable Advisory Opinion No. 23-15 on January 3, which concluded that a consultant’s proposal to provide gift cards to existing physician practice customers in exchange for referring other physician practices to the vendor would not implicate the federal Anti-Kickback Statute (AKS).
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Dec 20, 2023 | 
jdsupra.com | Albert W. Shay |Tesch Leigh West
Since our publication on disenrollments caused by the “unwinding” of Medicaid’s continuous enrollment condition, the Centers for Medicare and Medicaid Services (CMS) issued an interim final rule on December 6, 2023 implementing the requirement under the Consolidated Appropriations Act for CMS to withhold federal Medicaid funding from states that do not report monthly unwinding data.
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Dec 19, 2023 | 
morganlewis.com | Albert W. Shay |Tesch Leigh West
Since our publication on disenrollments caused by the “unwinding” of Medicaid’s continuous enrollment condition, the Centers for Medicare and Medicaid Services (CMS) issued an interim final rule on December 6, 2023 implementing the requirement under the Consolidated Appropriations Act for CMS to withhold federal Medicaid funding from states that do not report monthly unwinding data.
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Dec 6, 2023 | 
jdsupra.com | Albert W. Shay |Tesch Leigh West
Estimates show that Medicaid enrollment grew by more than 20 million (approximately 31%) during the public health emergency (PHE) and the top Medicaid managed care organizations (MCOs) experienced a 44.1% increase in managed care enrollment between March 2020 and March 2023. This increase has been largely attributed to the continuous enrollment condition, which conditioned certain federal funding on maintaining all Medicaid enrollments during the PHE.
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Dec 5, 2023 | 
morganlewis.com | Tesch Leigh West |Albert W. Shay
Estimates show that Medicaid enrollment grew by more than 20 million (approximately 31%) during the public health emergency (PHE) and the top Medicaid managed care organizations (MCOs) experienced a 44.1% increase in managed care enrollment between March 2020 and March 2023. This increase has been largely attributed to the continuous enrollment condition, which conditioned certain federal funding on maintaining all Medicaid enrollments during the PHE.
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Oct 27, 2023 | 
jdsupra.com | Felicia Alexander |Jacob Harper |Albert W. Shay
The US Department of Health and Human Services Office of Inspector General (OIG) recently released Advisory Opinion No. 23-07, in which OIG approved a proposed arrangement to pay employed physicians bonuses based on net profits derived from certain ambulatory surgery center procedures performed by the physicians.
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Oct 26, 2023 | 
morganlewis.com | Albert W. Shay |Jacob Harper |Felicia Alexander
The US Department of Health and Human Services Office of Inspector General (OIG) recently released Advisory Opinion No. 23-07, in which OIG approved a proposed arrangement to pay employed physicians bonuses based on net profits derived from certain ambulatory surgery center procedures performed by the physicians.
