On April 30, 2025, the Centers for Medicare & Medicaid Services (“CMS”) released the FFY 2026 Inpatient Prospective Payment System (“IPPS”) Proposed Rule (“Proposed Rule”) to update IPPS payment rates, change DSH payments, increase uncompensated care payments and request input on ways to streamline Medicare regulations and reduce provider burden.
Increase to Payment Rates Under the IPPS
CMS proposes to increase annual operating payment rates for IPPS hospitals by 3.2%, reduced by a productivity adjustment of 0.8 % for
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CMMI’s New Strategy: What’s Changing for Providers?
The Center for Medicare & Medicaid Innovation (“CMMI”) has announced a new strategy for establishing payment systems that incentivize healthier lives through a focus on three key pillars: (1) promoting evidence-based prevention; (2) empowering patients to achieve their health goals; and (3) driving choice and competition. This strategy includes several positives for providers participating (or considering participation) in CMMI’s alternative payment models, including efforts to reduce administrative burden for participants, increase predictability through reducing significant mid-model changes and increased
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D.C. Court of Appeals Joins Prohibition on Pro Se Pursuit of FCA Claims
In United States ex rel. Feliciano v. Ardoin, a pro se relator filed a qui tam action under the False Claims Act (“FCA”). On February 4, 2025, the D.C. Court of Appeals (the “Court”) affirmed a district court’s dismissal ruling that a pro se litigant cannot allege violations of the FCA. In doing so, the Court joined every other court of appeals to have addressed the question.
Background
The FCA, codified at 31 U.S.C. §§ 3729-3733, empowers
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How Can Medical Providers Defend Against Healthcare Fraud Charges?
Healthcare fraud is a serious offense that can result in significant penalties for medical providers. In addition to criminal charges that may lead to fines or imprisonment if a person is convicted, accusations of fraud can lead to the loss of a professional license, loss of provider status with Medicare and Medicaid, and damage to a provider’s personal reputation. If you are facing healthcare fraud charges, it is crucial to understand your rights and options for defense.
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Wisconsin Department of Health Services Increases Monthly Spousal Income Allowance
The Wisconsin Department of Health Services recently announced the “minimum monthly maintenance needs allowance” (“MMMNA”) will be increased from $2,873.34 to $2,903.34 starting on July 1, 2021. As part of laws designed to prevent spousal impoverishment due to the high cost of long-term care, the “community spouse” (who is the spouse of an individual receiving long-term care Medicaid benefits and who is still living in the “community”) is allowed to receive some or all of the Medicaid spouse’s monthly
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