Max Czernin

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CMS Proposes a National Healthcare Provider Directory: Beneficial or Burdensome?

In October 2022, the Centers for Medicare and Medicaid Services (“CMS”) requested information from the public regarding its proposal to establish a National Directory of Healthcare Providers and Services (“NDH”). This proposal was a response to recent CMS data showing that nearly half of Medicare Advantage plan directories were inaccurate, despite CMS’s quarterly reporting requirements. … Continue Reading

IDR Payment Disputes are Far Outpacing Projections, Creating Backlogs

The No Surprises Act (the “NSA”), which was enacted as part of the Consolidated Appropriations Act, 2021 (Pub. L. 116-260) provides protections to privately insured patients against “surprise billing” with respect to emergency services, non-emergency services provided by out-of-network providers at in-network health care facilities, and air ambulance services furnished by out-of-network providers.  As part … Continue Reading

AMA and AHA Challenge IDR Process under the No Surprises Act

The American Medical Association and the American Hospital Association filed suit under the Administrative Procedure Act in the District of Columbia District Court challenging portions of the interim final rule (the “Rule”) issued by the Department of Health and Human Services, the Department of Labor, the Department of the Treasury, and the Office of Personnel … Continue Reading

Third Circuit’s Rejection of the “Objective Falsehood” Requirement under the FCA is Challenged

The appellee in United States ex rel. Druding v. Care Alternatives, Inc., 952 F.3d 89 (3d Cir. 2020) has sought rehearing of the Third Circuit’s holding that “objective falsehood” is not a requirement under the False Claims Act (“FCA”).  In reaching this holding, the Third Circuit considered whether a hospice-care provider’s claim for Medicare reimbursement … Continue Reading

Tenth Circuit Reverses District Court and Upholds ACA’s Statewide Average Premium Risk Adjustment Methodology

In a unanimous decision, the United States Court of Appeals for the Tenth Circuit reversed a district court decision holding that HHS’ use of the statewide premium average to calculate Affordable Care Act (ACA) risk adjustment charges and payments from 2014 to 2018 was arbitrary and capricious.  See N.M. Health Connections v. U.S. Dep’t of … Continue Reading
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