In a recent striking example of the paramount role whistleblowers play in safeguarding the integrity of healthcare systems, a False Claims Act settlement has spotlighted the dark underbelly of laboratory kickback schemes... Read more »
USE OF AI IN COVERAGE DETERMINATIONS Stakeholders have raised questions concerning the role of artificial intelligence (AI), algorithms and similar tools in making coverage determinations. This discussion has attracted more attention as... Read more »
Effective Jan. 1, 2024, the Centers for Medicare and Medicaid Services (CMS) extended the so-called “36-month rule” to hospices, prohibiting a change in majority ownership of a hospice, as well as the transfer of... Read more »
On December 13, 2022, the Centers for Medicare and Medicaid Services (“CMS”) issued a proposed rule, titled Advancing Interoperability and Improving Prior Authorization Processes (“Proposed Rule”), to improve patient and provider access to health... Read more »
More than half of Medicare beneficiaries are enrolled in Medicare Advantage (MA), and enrollment in MA has steadily grown over the years. But as the MA program draws scrutiny from the federal... Read more »