On June 12, 2019, three Congressional committees have scheduled hearings on health care policy topics: The House Ways and Means Committee will hold a hearing entitled “Pathways to Universal Health Coverage.” The House Energy and Commerce Health Subcommittee will hold a hearing entitled “No More Surprises: Protecting Patients from Surprise Medical Bills.” The Senate Judiciary Antitrust Subcommittee is holding a hearing to examine the competitive implications of vertical consolidation in the health care industry.…

Federal health care fraud judgments and settlements totaled $2.3 billion in fiscal year (FY) 2018 – down from $2.6 billion in recoveries in FY 2017 and $3.3 billion in FY 2016 — according to latest Health Care Fraud and Abuse Control (HCFAC) Program Annual Report.  During FY 2018, the Department of Justice (DOJ) opened 1,139 new criminal health care fraud investigations, filed criminal charges in 572 cases involving 872 defendants, and launched 918 new civil…

The Centers for Medicare & Medicaid Services (CMS) has instructed state survey agencies that they must conduct onsite complaint investigations related to Emergency Medical Treatment and Labor Act (EMTALA) complaints and surveys of death in restraint or seclusion in hospitals and critical access hospitals within two business days instead of five.  This change brings these two categories of complaint investigations in line with other potential immediate jeopardy investigations in Medicare-participating non-long term care facilities.  The…

CMS has scheduled a June 27, 2019 listening session to get public feedback on its recent draft guidance on how state surveyors should evaluate hospital co-location arrangements for compliance with the Medicare hospital conditions of participation (COPs).  In particular, CMS is looking for input on how the guidance addresses staffing, contracted services, emergency services, and distinct and shared spaces.  The agency is accepting comments and questions in advance of the listening session (note that the…

The annual Advisory Panel on Hospital Outpatient Payment meeting will be held on August 19-20, 2019, the Centers for Medicare & Medicaid Services (CMS) has announced.  The Panel is charged with advising CMS on outpatient prospective payment system (OPPS) ambulatory payment classification clinical integrity and weights, along with hospital outpatient therapeutic services supervision issues.  The deadline for the submission of presentations and comments is July 22, and meeting registration runs through July 29.…

The House of Representatives has approved H.R. 987, the “Strengthening Health Care and Lowering Prescription Drug Costs Act,” which packages seven prescription drug and insurance-related bills recently approved by the House Energy and Commerce Committee.  The legislation is intended to:  increase generic drug competition; fund Affordable Care Act “Navigator” outreach and enrollment programs and state-based insurance marketplaces; and reverse Trump Administration policies on short-term, limited duration insurance (STLDI).  The bill was approved on a largely…

In a rare display of unity, President Donald Trump and bipartisan Congressional leaders have highlighted their shared commitment to tackling “surprise” medical billing – when an insured patient is subject to unexpectedly high out-of-pocket costs for out-of-network care that is beyond their control.  Such surprise billing can occur when a patient receives emergency care from an out-of-network provider but they could not choose their provider, or when a patient is treated at an in-network hospital…