Articles and Blogs

In a new report, the Department of Health and Human Services Office of Inspector General (“OIG”) concluded that hospitals are increasingly billing Medicare for inpatient stays at the highest, most expensive severity level despite many of these stays having only one qualifying diagnosis for payment at the highest severity level and others lasting only a…Read More

In an important development for 340B participating providers (“Covered Entities”), the Department of Health and Human Services (“HHS”) Office of General Counsel (“OGC”) published an Advisory Opinion stating its view that drug manufacturers must honor 340B program discounts under contract pharmacy arrangements. The Advisory Opinion was remarkable in the clarity and forcefulness of HHS’s position…Read More

Noncompliance cited as immediate jeopardy (“IJ”) is one of the most severe survey findings for certified Medicare and Medicaid provider entities. According to the Centers for Medicare & Medicaid Services (“CMS”), IJ “represents a situation in which entity noncompliance has placed the health and safety of recipients in its care at risk for serious injury,…Read More

With the transition towards value-based care, more health care providers recognize environmental factors play a significant role in health outcomes. As highlighted in a recent Hall Render article, these environmental factors, otherwise known as social determinants of health (“SDOH”), are the conditions in which people are born, live and age that affect one’s quality-of-life and…Read More

Hospitals and health care systems that successfully defend against frivolous FCA actions may oftentimes recover fees and expenses incurred as part of their defense. Recently, however, the United States District Court for the District of Utah broadly connected this “frivolous” standard with Rule 9(b)’s pleading requirements—a decision that may stave off whistleblowers who have not…Read More

The Centers for Medicare and Medicaid Services (“CMS”) published numerous updates to its rules for graduate medical education in 2020, many of which take effect in the early part of 2021. This client alert is Part 2 of our series providing insight into these CMS changes and more recent statutory changes. Part 1, which addresses…Read More