Articles and Blogs

On June 24, 2019, the Trump administration changed the game for the health care industry through the release of an executive order on price transparency. Entitled “Improving Price and Quality Transparency in American Healthcare to Put Patients First,” the executive order is aimed primarily at giving patients access to price and quality information about... READ MORE

On May 3, 2019, CMS released its long-awaited guidance on hospital co-location and shared service arrangements in the form of a draft survey memo (“Memo”), which is available here. The Memo clarifies how a hospital can co-locate with other health care entities without violating the Medicare Conditions of Participation (“CoPs”). CMS has been promising... READ MORE

In a new case from the Southern District of Ohio, US_v_MillenniumRadiology, the court denied a motion to dismiss a False Claims Act suit, finding that compliance with a safe harbor could only be raised on summary judgment. The court also found that uncompensated service as a medical director could form the basis for a False Claims... READ MORE

Prior to the government shutdown, Representative Jim McDermott of Washington introduced a bill that would end the hospital inpatient requirement for skilled nursing facility (“SNF”) coverage.   READ MORE

One of the main admission requirements for a skilled stay in a skilled nursing facility (“SNF”) is a three-day qualifying stay in an inpatient hospital.  In response to a question discussed on a recent Open Door Forum, the Centers for Medicare & Medicaid Services (“CMS”) released a memorandum discussing if a stay in a... READ MORE

Can the False Claims Act be used by the government or whistleblowers in quality of care cases? The Department of Justice seems to think so, based in significant part on the retention of overpayments amendments to the FCA by FERA and the PPACA. For more please read Retention of Overpayments under FERA and the... READ MORE

Under the Bundled Payments for Care Improvement initiative, organizations will enter into payment arrangements that include financial and performance accountability for episodes of care. The Centers for Medicare & Medicaid Services (CMS) hopes these models may lead to higher quality and more coordinated care at a lower cost to Medicare.   READ MORE

As a means of improving care to residents residing in Medicare/Medicaid nursing facilities, CMS announced on March 15, 2012 an initiative to help reduce avoidable hospitalizations.  Organizations interested in participating in this initiative must submit an application to CMS by June 14, 2012. The goal of the initiative is to improve care for residents... READ MORE

So-called “superbugs”, those bacteria strains that have developed resistance to antibiotics, have long generated high levels of concern for hospitals and long-term care facilities.  These infections are difficult to treat, and often generate serious complications for individuals with already impaired immune systems.  The Wall Street Journal (WSJ) today published a note detailing efforts by researchers... READ MORE

Earlier this week, we highlighted the implementation by Centers for Medicare & Medicaid Services (CMS) of enrollment revalidations and screening categories, and which categories CMS places certain long-term care providers. It is important for providers and suppliers to understand what each screening category (limited, moderate, or high) entails and be aware of any events... READ MORE