On July 31, 2024, the Centers for Medicare & Medicaid Services (CMS) published the Calendar Year 2025 Physician Fee Schedule (PFS) Proposed Rule. Among other changes, the 2025 PFS Proposed Rule includes additional proposed changes to the so-called “60-day rule” regarding returning identified overpayments. Initially established by the 2010 Affordable…
Much has been made of the recent end of Chevron deference and the impact it may have on the authority of federal regulations and the power of federal agencies. As the healthcare industry is heavily regulated by multiple federal agencies, administrations, and departments, it is natural to ask what impact…
Physicians and other clinical providers expend tremendous amounts of time and effort accurately documenting the medical care that they provide to patients. Usually, the documentation is intended to be read and understood by another physician, either the physician who created the record or another treating physician. It may also be…
The US Department of Justice (DOJ) recently filed its first criminal drug distribution prosecutions related to telemedicine prescribing through a digital health company. The indictments accused Done Global, Inc., its founder and CEO, its clinical president, and several other persons associated with the company of participating in a scheme to…
In May 2024, the House of Representatives Energy and Commerce Subcommittee on Health advanced the Telehealth Modernization Act of 2024 (H.R. 7623) with the goal of extending several Medicare telehealth flexibilities through 2026. This most recent bill comes after nearly two dozen other bills proposed by the Subcommittee to strengthen…
Private equity (PE) and venture capital firms have been expending their involvement and acquisitions in the healthcare industry for years. Many physicians, physician practices, other healthcare provider types, or their employees who are approached by PE regarding an acquisition may have questions regarding the proposed deal or some of the…
On April 26, 2024, the Department of Health and Human Services (HHS) published a Final Rule introducing compliance changes for reproductive healthcare information under the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule. Titled “HIPAA Privacy Rule to Support Reproductive Health Care Privacy,” the Final Rule prohibits disclosure of…
Earlier this month, the Michigan Department of Health and Human Services (MDHHS) awarded Comprehensive Health Care Program contracts for Michigan’s Medicaid health plans. Health plans administered under Michigan Medicaid provide access to healthcare services to nearly 2 million Michigan residents. In this recent award of health plan contracts, nine health…
On March 12, 2024, several senators wrote a letter to the Government Accountability Office (GAO) Comptroller General, requesting an investigation into the policies and procedures CMS has in place to prevent Medicare fraud, waste, and abuse. The senators noted that in 2022, GAO estimated there were $47 billion in improper…
As we noted previously, Medicare providers of wound care services continue to be the target of audits by Medicare contractors. Wound care services typically involve the application of allografts, skin substitutes, and related products to promote healing and support recovery. Due to the generally high reimbursement rates and need for…