Skip to main content
Keeping you afloat amidst the rising sea of regulations

UPDATE: CMS Provides New Guidance to Hospitals on How to Settle Inpatient Appeals

Representatives for the Centers for Medicare and Medicaid Services (CMS) held a conference call on October 9, 2014 to address ongoing questions and clarify the requirements for hospitals that want to settle the inpatient-status claims whose denials they have appealed. As discussed in a recent Arent Fox client alert,1 the CMS settlement offer will pay hospitals 68 percent of the amount at issue.

Nursing Facilities Still Struggle with Abuse Reporting Requirements

* The following alert was originally published in California Healthcare News (CHN). To read it on the CHN website, click here.

Government Gives Health Care Companies More Leverage in Their Negotiations with Physicians

Recent Cases Demonstrate Potential Exposure for Both Physicians and ProvidersHealth care organizations that contract with physicians can face potential liability (including millions of dollars in civil, criminal, and administrative penalties), as well as exclusion from participation in federal health care programs, under various laws (such as the Stark Law), the anti-kickback statute, and the False Claims Act (FCA).

CMS Announces Extension of Meaningful Use Hardship Exception

On October 7, 2014, the Centers for Medicare & Medicaid Services (CMS) announced plans to reopen and extend the deadline for eligible professionals and eligible hospitals to submit a hardship exception application for not demonstrating “Meaningful Use” of Certified Electronic Health Record Technology (CEHRT).

Hospitals Face Important Decision on Whether to Accept CMS Settlement Offer for Certain Claims on Appeal

Hospitals Can Settle Certain Claims Now for 68 Percent of Their ValueThe Centers for Medicare and Medicaid Services (CMS) recently announced a policy1 allowing acute care and critical access hospitals to settle inpatient-status claims currently on appeal in exchange for a partial payment equal to 68 percent of the claims’ net allowable amount. The claims eligible for the settlement are those that were billed on an inpatient basis but, according to Medicare contractors (particularly the RACs), should have been billed as outpatient or inpatient Part B claims.

Medical Emergency Teams Can Recoup Their Costs by Reducing Adverse Events

Studies analyzing the cost-effectiveness of certain medical practices can sometimes indirectly suggest other, seemingly-unrelated benefits to a health care organization’s bottom-line. Such is the case in a study (Study) of medical emergency teams (MET) published in Pediatrics (“Cost-Benefit Analysis of a Medical Emergency Team in a Children’s Hospital,” Pediatrics 2014; 134; 235 (Aug. 2014)).

Local Drug Take-Back Law Creates Regulatory Burden for Manufacturers

On September 30, 2014, the US Court of Appeals for the Ninth Circuit unanimously held that the first-in-the-nation Safe Drug Disposal Ordinance passed by Alameda County, California is constitutional.

The Department of Justice’s New Focus Could Place Health Care Executives at Risk

The US Department of Justice (DOJ) periodically makes statements announcing changes in its planned approach to prosecuting corporations generally. As attorneys for health care providers, we pay close attention to those statements because they often are of particular interest to our clients. On September 25, 2014, Law360 published an article by Arent Fox partner Peter R. Zeidenberg that addresses just that type of DOJ statement.

OIG Finds Commercial Drug Copay Coupons Are Being Used by Medicare Part D Beneficiaries and Warns of Anti-Kickback Statute Exposure

On September 19, 2014, the Department of Health and Human Services Office of Inspector General (OIG) released a Special Advisory Bulletin (SAB) in tandem with the results of an OIG report entitled “Manufacturer Safeguards May Not Prevent Copayment Coupon Use for Part D Drugs” (Report on Copay Coupons) reinforcing the government’s position that the provision of cost-sharing assistance or “coupons” by pharmaceutical manufacturers to or for use by federal health care program beneficiaries implicates the federal Anti-Kickback Statute (AKS).