The Centers for Medicare & Medicaid Services (CMS) has revised certain payment policies under the Medicare physician fee schedule, and updated provider and supplier enrollment regulations. CMS recently published a final rule (the Final Rule) effective January 1, 2024. Technical and typographical errors in the Final Rule were later corrected by a subsequent final rule (the Subsequent Rule), effective February 12, 2024. Of the changes addressed herein, only the new “stay of enrollment” was impacted by the Subsequent Rule. Summary of Major Updates The below outlined changes are described in m ..read more

Hospitals, urgent care clinics, doctors’ offices — these are the places we go when we are sick and want to get better. Doctors, nurses, and other healthcare workers are the people who treat us, help us recover, and even save our lives in medical emergencies. Yet according to the U.S. Bureau of Labor Statistics, healthcare workers are five times more likely to experience workplace violence than workers in all other industries, and this statistic has only increased since the COVID-19 pandemic. Because of this rising concern, the Occupational Safety and Health Administration (OSHA) has identified ..read more

By maintaining a robust compliance program, healthcare companies are better able to identify potential red flags early and to prevent violations of fraud and abuse laws. A failure to maintain an effective compliance program may become particularly problematic for companies with business transactions on the horizon as the government increasingly incentivizes business professionals to give compliance a seat at the deal table. On October 4, 2023, Deputy Attorney General Lisa Monaco announced a new Department of Justice (DOJ) safe harbor policy (the DOJ Announcement), which incentivizes voluntary ..read more

Applicants for a health maintenance organization (HMO) certificate of authority (COA) in Florida must use a new application form effective January 28, 2024. After rule development by the Florida Office of Insurance Regulation, the Florida Department of Financial Services adopted amendments to Rule 69O-C1-942, F.A.C. The amendment incorporates changes to the Florida HMO COA application (Form OIR-C1-942). The prior version of the application includes the revision number “REV 5/22″ below the form number in the lower left corner of the application. The revised version will have revision number “Re ..read more

With a couple of “firsts,” the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) is signaling that it is cracking down on healthcare organizations that fail to identify and address cybersecurity vulnerabilities as required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA Rules). On October 31, 2023, OCR issued its first settlement agreement under the HIPAA Rules related to a ransomware attack (the Ransomware Settlement) and on December 7, 2023, its first settlement under the HIPAA Rules arising from a phishing cyber-attack (the Phishing S ..read more

The Office of Inspector General of the U.S. Department of Health and Human Services (the OIG) recently released an updated General Compliance Program Guidance document (GCPG). The GCPG has been anticipated since the OIG announced on April 25, 2023, that it planned to modernize the accessibility and usability of its publicly available resources, including the OIG’s Compliance Program Guidance (CPG) documents. We recommend that the healthcare compliance community and other healthcare stakeholders review the GCPG carefully, and, in particular, that all healthcare compliance officers ensure they u ..read more

Pharmacy Benefit Managers (PBMs) take note! Under Florida’s new Prescription Drug Reform Act, PBMs must be licensed as an insurance administrator (also known as a third-party administrator, or TPA). Under this new law, any entity that wishes to provide PBM services after January 1, 2024, must be licensed as a TPA. The Florida Office of Insurance Regulation (OIR) has adopted a new TPA license application that incorporates the additional licensing requirements for PBMs. The TPA license application is available here. For an entity that is not currently registered as a PBM, that entity will, in ad ..read more

Providers finally obtained court ordered relief to the $350 administrative fee each party was being required to pay as part of the Federal Independent Dispute Resolution (IDR) Process under the No Surprises Act. Until the Departments of Health and Human Services, Labor, and the Treasury (collectively, the Departments) set a new administrative fee amount, the administrative fee amount for disputes initiated on or after August 3, 2023, will now be $50 per party per dispute. The Texas Medical Association (TMA) brought suit against the Departments, arguing that the $350 administrative fee was proh ..read more

How could alleged kickbacks threaten to render insolvent a publicly traded company with assets (taken from its latest SEC filing) in excess of $43 billion? The answer stems from a recent decision by the United States District Court for the District of Massachusetts. In its ruling denying the motion for summary judgment filed by defendants Teva Pharmaceuticals USA, Inc. and Teva Neuroscience, Inc. (collectively Teva) and granting the government’s partial summary judgment motion, the court ruled that The causation requirement for a False Claims Act (FCA) violation predicated on a kickback prohi ..read more

On July 20, 2023, the U.S. Department of Health and Human Services Office for Civil Rights (OCR) and the Federal Trade Commission (FTC) announced they were sending a joint letter to approximately 130 unidentified hospital systems and telehealth providers highlighting the agencies’ concerns about the use of tracking technologies on websites and mobile apps in violation of HIPAA.  While the joint letter was directed to a small number of recipients, in the announcement OCR and the FTC encouraged all companies they regulate to review their data-tracking practices and ensure that their trackin ..read more