Articles and Blogs

In September 2018, HHS Office of Inspector General (“OIG”) issued audit Report No. A-01-15-00500 (the “Report”) finding that out of 220 randomly sampled inpatient rehabilitation facility (“IRF”) stays from 2013, nearly 80 percent did not meet Medicare coverage and documentation requirements. Specifically, for 175 of the 220 sampled stays at 135 IRFs, the medical record... READ MORE

Recently, the Wisconsin Supreme Court affirmatively ruled that an employee’s violation of his or her employer’s written absenteeism policy constituted “misconduct” under Wis. Stat. § 108.04(5), even where the employer’s absenteeism policy was more stringent than the definition of absenteeism outlined under the statute. In doing so, the Court reversed a decision by the... READ MORE

NATIONAL Healthcare job growth continues; hospitals add 12K positions in September 12 recent hospital, health system outlook and credit rating actions MGMA18: Physicians frustrated over lack of advanced APMs Want your medical records? Better be prepared to call—and pay up Hospitals and physician groups take on risk in BPCI Advanced model 10 informative Q&As... READ MORE

To be paid by Medicare, Organ Procurement Organizations (OPOs) and transplant centers must be members of the United Network for Organ Sharing (UNOS), which manages the Organ Procurement and Transplantation Network (OPTN). Transplant centers and OPOs must comply with multiple oversight agencies and requirements, including OPTN policies and guidelines and the Medicare Conditions of... READ MORE

NATIONAL Verma puts Medicaid insurers on notice, says CMS will begin ‘targeted audits’ While surgery centers support CMS payment proposal, hospital groups submit harsh criticism Supreme Court to hear DSH payments case Banner Health, Ascension executives join hundreds of hospital CEOs defending 340B program MGMA shares physician practice keys to success MGMA18: Underwhelming MIPS... READ MORE

On September 17, 2018, the U.S. Department of Justice (“DOJ”) approved the $52 billion vertical merger between health insurer Cigna Corp. (“Cigna”) and pharmacy benefit manager (“PBM”) Express Scripts. The Cigna-Express Scripts merger is just one in a string of recent health insurer/PBM acquisitions. For more on these transactions, click here. As the largest unaffiliated... READ MORE

They’re at it again! On August 28, 2018, the Department of Labor’s Wage and Hour Division issued six opinion letters. This was the second batch of opinion letters from the Wage and Hour Division in a matter of months. The Wage and Hour Division, which hadn’t published new opinion letters since 2010, previously issued... READ MORE

A recent denial of summary judgment by a U.S. District Court in New York reminds us that bias-based comments can have serious consequences for hospitals and other employers, including that their employment decisions may be undermined. The ruling also suggests that, in certain situations, requiring a waiver of claims may be considered retaliatory. Facts... READ MORE

Congress Sends Health Funding Package to President Congress completed the funding package for the 2019 Labor-HHS appropriations measure, which hikes funding for most Health and Human Services (“HHS”) agencies. On Wednesday, the House of Representatives voted, 361 to 61, to pass legislation to provide $178.1 billion in discretionary funding for the departments of Defense,... READ MORE

NATIONAL How providers can innovate to combat physician burnout CMS: Innovative new payment models are coming—and some will be mandatory Lack of consistent process hinders data sharing among HHS agencies, report finds Apple Watch Should Pave Way for More Medical Gadgets, FDA Says Pharma lobby mounts last-ditch effort to fix prescription ‘doughnut hole’ Less... READ MORE