March 24, 2023

CMS issued notice on March 24, 2023 to Medicare Advantage Organizations, Part D Plan Sponsors, and Medicare-Medicaid Plans that the temporary enforcement discretion policy would end when the PHE ends on May 11, 2023.  This means the flexibilities these organizations implemented during the COVID-19 PHE will end and they will need to follow current statutory and regulatory requirements. 

March 21, 2023

HealthExec’s March 20, 2023 article listed the top 10 best & worst states for physicians. This ranking was based on research conducted by WalletHub who compare the 50 states and the District of Columbia across 19 key metrics, including salary, number of hospitals in the per capita area, and quality.

March 17, 2023

Former Naval officer, Jordan Thomas Broome, has been sentenced to 66 months in prison for submitting fraudulent Durable Medical Equipment (DME) claims of over $2.15M.  Aided by other bad actors (providers who would “robo-sign” prescriptions for DME equipment for patients never seen), Broome illegally obtained over 2,000 Medicare beneficiaries’ personal information and mailed them DME equipment which they never asked for, nor needed.  Read the full Press Release.

March 14, 2023

The Supreme Court of the United States (SCOTUS) denied Pfizer’s petition to review the Second Circuit’s Court of Appeals ruling that found Pfizer in violation of the anti-kickback statute.  Two of Pfizer’s cardiac medications have a patient out-of-pocket cost of more than $1,000 per month. 

March o2, 2023 With the Public Health Emergency (PHE) expiring on May 11, 2023, CMS updated their CMS PHE Fact Sheet on February 27, 2023. This fact sheet covers the following: COVID-19 vaccines, testing, and treatments; Telehealth services; Health Care Access: Continuing flexibilities for health care professionals; and Inpatient Hospital Care at Home: Expanded hospital…

March 02, 2023

As mentioned in a previous article, an individual or entity can be excluded from participating in Federal health care programs for a variety of reasons.  The individual/entity will receive notification from the OIG indicating the period of time for which they are going to be excluded. 

02/28/23

In January 2023, the Office of the Inspector General (OIG) collected over half-a-million dollars in Civil Monetary Penalties (CMP) from three health care organizations that employed individuals who were excluded from participating in any Federal health care program.

02/27/23

On January 24, 2023, CMS conducted its quarterly stakeholder call and reviewed 2022 successes and provided a high-level overview of their 2023 plans and initiatives.  CMS Strategic Pillars (see infographic) were highlighted by each CMS leader who discussed their area of responsibility. 

02/14/23

On February 9, 2023, the Department of Health and Human Services (HHS) released a Fact Sheet providing a Public Health Emergency (PHE) Transition Roadmap.  DHHS Secretary Xavier Becerra confirmed that the PHE would end on May 11, 2023.  Below are a few items from the Fact Sheet.  Access this link to view the Fact Sheet in entirety:  https://www.hhs.gov/about/news/2023/02/09/fact-sheet-covid-19-public-health-emergency-transition-roadmap.html

02/01/23

On Monday, January 30, 2023, President Joe Biden announced that the public health emergency (PHE) will end on May 11, 2023.   There will be many changes as a result of the PHE ending.  One in particular will be the delivery, coding and billing of telehealth services.  CMS had expanded telehealth benefits temporarily during the PHE through the Corona Virus Waiver 1135.  There is a 151-day transition period, after the end of the PHE, for the required changes to take place.