Category Archives: Affordable Care Act of 2010

IRS Revokes Hospital’s Nonprofit Status for Failure to Meet the Community Needs Assessment Requirements Under Internal Revenue Code Section 501(r)

The Internal Revenue Service (IRS) has, for the first time, revoked a hospital’s nonprofit tax status for failure to meet the community needs assessment requirements under Internal Revenue Code (IRC) section 501(r). The hospital, which has not been identified, received a tax status letter from the IRS dated February 14, 2017 that was publicly released earlier this month. The IRS informed the hospital organization that it had failed to comply with the requirements of section 501(r) requirements to conduct a community health needs assessment, adopt an implementation strategy and make it widely available to the public. Continue reading

Final Rule Released to the OIGs Exclusion Authorities

On January 11, 2017, the Office of Inspector General (OIG) of the Department of Health and Human Services released a final rule that incorporates statutory changes, early reinstatement provisions, and policy changes, and clarifies existing regulatory provisions to the OIG’s authorities to exclude persons and entities from participating in Federal health care programs. The Affordable Care Act of 2010 expanded the OIG’s authority to exclude various individuals and entities from participation in Federal health care programs under section 1128 of the Social Security Act (Act). The changes in the final rule to the OIG’s authority were also based on the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), which amended the OIG’s authority to waive certain exclusions under section 1128 of the Act.

A copy of the final rule is available at: http://go.usa.gov/x9Ugu

Written by: Clay J. Countryman

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Plans Offered by Insurers on Louisiana’s ACA Exchange Hiking Rates by Double-Digits

Nearly 211,000 Louisiana residents covered under an “Obamacare” plan can expect to see rate hikes between 16.4 and 30.75 percent in 2017. The premium hikes are meant to cover the massive losses the plans have accumulated. Insurer’s filings with the Louisiana Insurance Department detail enrollee’s increased use of services, higher costs of benefits and prescription drugs and lower payments from a federal program meant to protect insurers from unexpectedly high claims and losses. Among the plans proposing increases are Blue Cross and Blue Shield of Louisiana, Aetna Health Inc., Humana Health Benefit Plan of Louisiana Inc., and Vantage Health Plan Inc. In April, UnitedHealth pulled itself from the ACA Exchanges in Louisiana and most other states after it says their plans in those states accumulated losses of more than $1.1 billion nationally over a two-year period. UnitedHealth’s departure from Louisiana’s ACA Exchange will leave approximately 29,000 people looking for a new insurer for 2017.

Hot Off the Presses! CMS Issues Final Overpayment Regulations

On Friday, February 12, 2016, the Centers for Medicare and Medicaid Services (CMS) issued the final overpayment reporting and refunding rule for Medicare Parts A and B overpayments (Final Rule). This Final Rule adopts federal regulations to implement Section 6402(a) of the Affordable Care Act (ACA) enacted in March 2010 that requires the identification, reporting and refunding of certain overpayments from the Medicare and Medicaid programs (the “Overpayment Law”). CMS had previously issued a proposed rule in February 2012 containing regulations to implement the Overpayment Law, which raised several questions and compliance challenges by physicians and other health care providers. Continue reading

King v. Burwell: Supreme Court Upholds Federal Exchanges

On June 25, 2015, the U.S. Supreme Court rendered a decision in the highly anticipated case of King v. Burwell[1], which centered around the viability of certain provisions of the Patient Protection and Affordable Care Act (“ACA”). The King decision, rendered three months after arguments were heard, decided an issue the Court described as “a question of deep ‘economic and political significance.’”[2]  Specifically, the Court decided whether the ACA intended for tax credits to be available to individuals who purchased their insurance through either a State or Federal Exchange or just through a State Exchange. Ultimately, the Court held both State and Federal Exchanges should offer tax credits to purchasers. Continue reading

New York Whistleblower Court First to Address What It Means to “Identify” Overpayment under ACA’s 60 Day Rule

For the first time since its enactment as part of the Affordable Care Act (ACA) in 2010, a federal court in a whistleblower action will consider a provision requiring providers to return overpayments within sixty days of when they are “identified.”  The upcoming decision by the United States District Court for the Southern District of New York in U.S. ex rel. Kane v. HealthFirst Inc. et al  will likely be just  the first of many decisions on the subject.   Providers and government regulators are poised for what could prove a lengthy dispute at both the trial and appellate levels around the ACA’s 60 day rule and its interplay with overpayments in the False Claims Act (FCA) context. Continue reading

OIG Issues Proposed Rule to Add New Safe Harbors and CMPs on Beneficiary Inducements and Gainsharing

The Office of Inspector General (OIG) issued a Proposed Rule on October 2, 2014 that would amend the safe harbors to the Anti-Kickback Statute and the civil monetary penalty (CMP) rules to add new safe harbors to codify statutory changes in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) and the Patient Protection and Affordable Care Act, that would protect certain payment practices and business arrangements from criminal prosecution or civil sanctions under the Anti-Kickback Statute.  The OIG also proposed to codify certain revisions to the definition of “remuneration,” added by the Balanced Budget Act (BBA) of 1997 and ACA and add a gainsharing CMP provision in the OIG’s regulations. Continue reading

Louisiana Health Insurance Exchange Roll-Out Includes Some Interesting Questions

In November, 2012, Louisiana health officials declined to create a state-run exchange, leaving it to the federal government to operate a marketplace for Louisiana residents. Only recently has any real clarity on the structure of the Louisiana Health Insurance Exchange been available for its October 1, 2013 opening date. Continue reading