Health Care Fraud and Abuse Control Program FY 2021 Report Issued

From the Health Group

The Department of Health and Human Services and the Department of Justice have released the Health Care Fraud and Abuse Control Program Annual Report for Fiscal Year 2021. 

During FY 2021, the federal government won or negotiated more than $5 billion in health care fraud judgments and settlements.  The Report provides highlights of significant criminal and civil investigations by type including:

• Ambulance transportation services
• Clinics
• Diagnostic testing
• Drug companies
• Durable medical equipment
• Electronic health records
• Genetic testing
• Home health providers
• Hospice care
• Hospitals and health systems
• Laboratory testing
• Managed care
• Medical devices
• Nursing homes and facilities
• Pharmacies
• Physical therapy
• Physicians and other practitioners
• Prescription drugs and opioids
• Psychiatric and psychological testing and services
• Substance use treatment centers

The Report provides an all-inclusive look into the current and potential activities relating to the identification and pursuit of fraudulent and abusive activities, including Medicare provider screening.  All providers should be continuously aware of areas of focus as described in the Report.  The entire Report is available at FY 2021 HCFAC Report (hhs.gov).

MEDPAC Releases June Report to Congress

The Health Group 

The Medicare Payment Advisory Commission (“MedPAC”) has released the June 2022 Report to Congress, Medicare and the Health Care Delivery System.  The Report includes seven (7) chapters devoted to:

• Ways to streamline and harmonize Medicare’s portfolio of alternative payment models,
• Vulnerable Medicare beneficiaries’ access to care,
• A framework for identifying safety-net providers,
• Addressing the high prices of drugs covered by Medicare Part B,
• Improving the accuracy of Medicare Advantage payments,
• Aligning fee-for-service payment rates across ambulatory settings, and
• Segmentation in the stand-alone Part D prescription drug plan market.

The entire Report is available here. 

Dems Want to Tax High Earners to Protect Medicare Solvency

Associated Press | By ALAN FRAM
 
WASHINGTON (AP) — Senate Democrats want to boost taxes on some high earners and use the money to extend the solvency of Medicare, the latest step in the party’s election-year attempt to craft a scaled-back version of the economic package that collapsed last year, Democratic aides told The Associated Press.
 
Democrats expect to submit legislative language on their Medicare plan to the Senate’s parliamentarian in the next few days, the aides said. It was the latest sign that Majority Leader Chuck Schumer, D-N.Y., and Sen. Joe Manchin, D-W.Va., could be edging toward a compromise the party hopes to push through Congress this summer over solid Republican opposition. Manchin scuttled last year’s bill.
 
Under the latest proposal, people earning more than $400,000 a year and couples making more than $500,000 would have to pay a 3.8% tax on their earnings from tax-advantaged businesses called pass throughs. Until now, many of them have been using a loophole to avoid paying that levy.
 
That would raise an estimated $203 billion over a decade, which Democrats say would be used to delay until 2031 a shortfall in the Medicare trust fund that pays for hospital care. That fund is currently projected to start running out of money in 2028, three years earlier.
 
Most U.S. businesses are pass throughs, which include partnerships and sole proprietorships and range from one-person law practices to some large companies. Owners count the profits as income when they pay individual income taxes, but such companies do not pay corporate taxes — meaning they avoid paying two levels of taxation.
 
Democrats this week also sent the parliamentarian a separate 190-page piece of the emerging Schumer-Manchin compromise that would lower prescription drug costs for patients and the government. Provisions include requiring Medicare to negotiate drug prices, limiting beneficiaries’ out-of-pocket costs to $2,000 annually and increasing federal subsidies for copays and premiums for some low-income people.

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Biden-Harris Administration Takes Action to Expand Access to Emergency Care Services in Rural Communities

CMS proposes new rule that creates a pathway for rural hospitals and critical access hospitals to increase access to emergency and outpatient care

Today, as part of the Biden-Harris Administration’s ongoing effort to strengthen rural health, the Centers for Medicare & Medicaid Services (CMS) is releasing a new proposed rule protecting access to emergency care and additional outpatient services for people in rural communities. CMS is establishing the Conditions of Participation (CoPs) for Rural Emergency Hospitals (REHs). The proposed rule will allow small rural hospitals to seek this new health care provider designation and provide continued access to emergency services, observation care, and additional medical and outpatient services. In accordance with the statutory legislation, REHs will be eligible to receive payment for services provided on or after January 1, 2023. This is a significant step in building on the Administration’s efforts to reduce health care disparities and maintain access to services in rural communities.

Rural communities represent a fifth of the U.S. population, and the Department of Health and Human Services (HHS) is committed to improving health outcomes and promoting health equity in rural America. Since 2010, 138 rural hospitals have closed — with a record-breaking 19 hospitals closing in 2020 alone. These closures occur disproportionately within communities with a higher proportion of people of color and communities with higher poverty rates. Rural communities experience shorter life expectancy, higher mortality, and have fewer local health care providers, leading to worse health outcomes than in other communities. Rural hospital closures deprive people living in rural areas of crucial services, including access to emergency care.

“The availability of the new Rural Emergency Hospital provider type will maintain access to essential health care services and help to reduce disparities in rural communities,” said CMS Administrator Chiquita Brooks-LaSure. “CMS is committed to advancing health equity, driving high-quality person-centered care, and promoting the sustainability of our programs. Today’s action to strengthen rural health furthers our goal of ensuring everyone served by our programs the has access to quality, affordable health care.”

To address these concerns, CMS is implementing a new Medicare provider designation called REHs, which will provide an opportunity for small rural hospitals and CAHs to right-size their service footprint and avoid potential closure so they can continue to provide essential services for their communities. The REH provider type was established by the Consolidated Appropriations Act of 2021 to address the growing concern over closures of rural hospitals. . .

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For more information on the Rural Emergency Hospital and Critical Access Hospital Conditions of Participation, visit: https://www.federalregister.gov/public-inspection/current

To read the Fact Sheet on the Rural Emergency Hospital and Critical Access Hospital Conditions of Participation, visit: https://www.cms.gov/newsroom/fact-sheets/conditions-participation-rural-emergency-hospitals-and-critical-access-hospital-cop-updates-cms-3419.

To read the Fact Sheet on HHS actions to strengthen rural health, click here.