Health Care Finance

Under the expanded Medicare Accelerated and Advance Payments Program, more than 22,000 Medicare Part A providers and 28,000 Medicare Part B suppliers requested and received accelerated or advance payments from the Centers for Medicare & Medicaid Services to help ease financial strain and uncertainty caused by the COVID-19 pandemic.

Chapman attorneys Amy Cobb Curran and David Kates participated in a webinar hosted by Warbird Consulting Partners. 

The Paycheck Protection Program and Health Care Enhancement Act was signed into law today. This alert summarizes key portions of the Act and recently released information from the Department of Health and Human Services explaining its plans to allocate and distribute the Provider Relief Fund money.

The Coronavirus Aid, Relief, and Economic Security Act, a bill designed to provide financial support and resources to individuals and businesses affected by COVID-19 pandemic, was signed into law on March 27. This client alert summarizes notable CARES Act provisions for health care businesses, including hospitals and physician practices.

A health care management services organization provides non‑clinical, administrative support services to physician group practices and other health care providers. One of the primary purposes of a MSO is to relieve licensed health care providers of non-medical business functions so they can focus on the clinical aspects of their medical practices.

This update includes: 

• Congress Returns from Recess to Tackle Health Care Reform; Obamacare Marketplace Insurer Participation Deadline Looms
• Hospitalist Group Pays $4.2 Million to Settle Upcoding Allegations
• $155 Million Settlement Demonstrates That Failure to Comply with Meaningful Use Certification Requirements May Expose IT Vendors to FCA “False Certification” Liability

This update includes:

• CBO Releases Score of House’s American Health Care Act
• United States Files Second False Claims Act Complaint against UnitedHealth This Month 
• Missouri Hospital and Clinic to Pay $34 Million to Settle Allegations That Compensation Paid to Oncologists Violated the Stark Law

This update includes:

• American Health Care Act Passes House, but May Be Stalled in the Senate
• Three HIPAA Corrective Actions Announced in April; First Settlement with Wireless Health Services Provider Costs $2.5 Million
• Blood Testing Laboratory to Pay $6 Million to Settle Allegations of Kickbacks and Unnecessary Testing 

This update includes: 

• As Genetic Testing Booms and Fraud and Abuse Scrutiny Increases, Providers Need to Keep Medical Necessity in Mind
• House Republican Leaders Attempt to Revive the American Health Care Act with Risk-Sharing Fund Amendment
• Failure to Conduct a HIPAA Security Risk Assessment Results in Fine and Corrective Action Plan for Federally Qualified Health Center 

This update includes:

• Amid Deep Program Cuts, President’s Budget Blueprint Increases Health Care Fraud and Abuse Enforcement Spending by 10 Percent
• CMS Rolls Out New Stark Law Self-Disclosure Form
• Kansas Governor Vetoes Medicaid Expansion; Legislature Fails to Override

This update includes: 

• Favorable OIG Advisory Opinion Provides Helpful Roadmap in Structuring a Patient Lodging/Meals Assistance Program that Complies With Federal Law
• Kansas Votes to Expand Medicaid, Embracing a Key Measure of the Affordable Care Act; Veto Possible 
• With AHCA Withdrawn, What’s Next for Health Care Reform?  

On March 13, the Congressional Budget Office released its highly anticipated score of the American Health Care Act, the Republican-proposed replacement bill for the Affordable Care Act.

This update includes:

• Five Things to Know as the American Health Care Act Moves Through the House
• Hospital Associations and American Medical Association Oppose ACA Replacement Bill 

This update includes:

• Oncology Practice, Practice Manager and Physician Pay $1.7 Million to Resolve Allegations of Billing Medicare for Unapproved Chemotherapy Drugs
• Federal Regulators Issue Proposed Rule Aimed at Stabilizing Insurance Marketplaces as ACA is Debated; Trump’s “One In, Two Out” Executive Order Determined Inapplicable 
• House Republicans and Trump Administration File Joint Motion to Indefinitely Delay Resolution of Lawsuit with Potential to Dismantle ACA Insurance Exchanges 

This update includes:

• Weekly Health Care Criminal and Civil Fraud Enforcement Round-Up  
• Office of Budget Management Withdraws Proposed Omnibus Guidance for 340B Drug Pricing Program
• Failure to Respond Timely to HIPAA Notice of Proposed Determination Results in $3.2 Million Penalty
• Anthem-Cigna Merger Blocked by Federal Judge
• Joint Commission Clarifies That It Prohibits Secure Texting for Patient Orders

This updated includes:

• Weekly Health Care Criminal and Civil Fraud Enforcement Round-Up
• $2.2 Million HIPAA Settlement Demonstrates Importance of Conducting Required HIPAA Security Risk Assessments and Implementing ePHI Safeguards
• CBO Releases Report on How Repealing Portions of the ACA Would Affect Health Insurance Coverage and Premiums

This update includes:

• Weekly Health Care Criminal and Civil Fraud Enforcement Round-Up
• New Rule Imposes Civil Monetary Penalties on Drug Manufacturers That Overcharge Safety Net Providers for 340B Outpatient Drugs
• Senate Takes Step Towards Dismantling Affordable Care Act

This update includes:

• Weekly Health Care Criminal and Civil Fraud Enforcement Round-Up
• Food and Drug Administration Delays Off-Label Promotion Guidance 
• 21st Century Cures Act Signed into Law 

This update includes:

• Weekly Health Care Criminal and Civil Fraud Enforcement Round-Up
• OIG Issues Long-Awaited Final Rule with Revisions to the Anti-Kickback Statute and Civil Monetary Penalty Rules Regarding Beneficiary Inducements
• Despite Industry Pushback, FDA Finalizes Policy Regarding Public Notification of “Emerging” Medical Device Safety Issues   

This update includes:

• Weekly Health Care Criminal and Civil Fraud Enforcement Round-Up
• CMS Releases National Health Expenditure Data for 2015 
• UMass Settles Potential HIPAA Violations Following Malware Infection
• Highlights of the OIG Semi-Annual Report to Congress

This update includes:

• Weekly Health Care Criminal and Civil Fraud Enforcement Round-Up
• House Republicans Urge Federal Agencies to Cease Rulemaking until President-Elect Trump Takes Office
• OIG Releases Its Fiscal Year 2017 Work Plan

This update includes:

• Full Repeal of Affordable Care Act Unlikely 
• CMS Hosting a MACRA Quality Payment Program Informational Call Tomorrow
• Jury Convicts Home Health Agency Owner in $13 Million Medicare Fraud Conspiracy

This update includes:

• Medical Device Manufacturer Pleads Guilty to Misbranding and Agrees to Pay $36 Million to Resolve Criminal Liability and False Claims Act Allegations
• Federal District Court Blocks CMS Rule Banning Pre-Dispute Binding Arbitration Clauses
• CMS Releases CY 2017 Final Rule Implementing Changes to Medicare Outpatient Prospective Payment System
• Fewer Hospitals to Receive Value-Based Purchasing Program Bonuses in 2017

This update includes:

• Weekly Health Care Criminal and Civil Fraud Enforcement Round-Up
• First Circuit Rules That HHS Had Right to Recoup Disproportionate Share Overpayments Payments from Maine Hospitals 
• Vermont’s All Payer ACO Approved by CMS to Begin in January 2017 

This update includes:

• Obamacare Enrollment Predicted to Increase by 9% in 2017 Open Enrollment
• Skilled Nursing Facility Provider to Pay $145 Million to Resolve False Claims Act Allegations
• Dignity Health and Catholic Health Initiatives in Alignment Talks

This update includes:

• Weekly Health Care Criminal and Civil Fraud Enforcement Round-Up
• Transition to Value-Based Reimbursement Continues as CMS Releases MACRA Final Rule
• HHS Publishes Guidance on HIPAA and Cloud Computing

This update includes:

• Weekly Health Care Criminal and Civil Fraud Enforcement Round-Up
• Vermont Granted Tentative Approval for All Payer Reimbursement System
• CMS Issues Final Rule for Long-Term Care Facilities
• MedPAC Unsatisfied with Savings Generated by Medicare Shared Saving Program ACOs

This update includes:

• Weekly Health Care Criminal and Civil Fraud Enforcement Round-Up
• GAO Report Highlights Electronic Health Record Vulnerability to Cyber Threats and Recommends HHS Update and Strengthen its HIPAA Guidance and Oversight
• CMS Seeking Comments by October 11, 2016 Regarding Updates to the Voluntary Self-Referral Disclosure Protocol

This update includes:

• Potential Penalties for False Claims Act Violations Continue to Rise
• Medicaid Fraud Control Unit FY 2015 Annual Report Highlights Criminal and Civil Fraud Recoveries; Civil Settlements, Judgments and Recovery Amounts Have Decreased
• OIG Data Brief Indicating Escalating Medicare Billings for Home Respiratory Ventilators May Result in Targeted Program Integrity Efforts
• Comment Period for New Bundled Payment Models Closing October 3rd 

On Oct. 27, 2015, the United States Treasury Department and the Internal Revenue Service published long-awaited final regulations that provide welcome guidance to 501(c)(3) health care organizations that are borrowers of qualified 501(c)(3) bonds.