Health Care Fraud Prevention and Enforcement Act

Issues related to prior authorization requirements in Medicare, including H.R. 3514/S. 1816, the Improving Seniors Timely Access to Care Act of 2025 Issues related to Medicare coverage of audiology services and the Medicare Audiology Access Improvement Act (H.R. 2757/S. 1996) Issues related to the provision of audiology and speech-language pathology services through telepractice, including H.R. 1614, legislation to amend title XVIII of the Social Security Act to expand practitioners eligible to furnish telehealth services under the Medicare program, H.R. 5801, H.R. 6296, the Advancing Access to Telehealth Act, the Telehealth Modernization Act (H.R. 5081/S. 2709), and S. 3834, the Expanded Telehealth Access Act. Issues related to Medicare Part B reimbursement of audiology and speech-language pathology services, including H.R. 8163, the Provider Reimbursement Stability Act of 2026 Issues related to the Multiple Procedure Payment Reduction, including the Removing Excessive Cuts to Outpatient and Vital Essential Rehabilitation (RECOVER) Act (H.R. 8386) H.R. 6160, Strengthening Medicare for Patients and Providers Act H.R. 7520, the Efficiency Adjustment Delay Act Provider Reimbursement Stability Act (H.R. 8163) Patients First Act (H.R. 9693) Prompt and Fair Pay Act (H.R. 4559) Medicare Patient Choice Act (H.R. 4204) Stopping Fraudulent Payments Act (H.R. 8464) Protecting Health Care and Lowering Costs Act (H.R. 4849/S. 2556) Health Care Fraud Prevention and Enforcement Act (S. 5326) H.R.6500, the Continuing Appropriations and Extensions Act, 2027 Various issues related to CMS Actions surrounding: o Audits of medical records and claims for Part A and B services o Procedure code development and valuation of audiology and speech-language pathology services o Quality reporting under MIPS o Implementation of the IMPACT Act o Medicare physician fee schedule o Prospective payments systems, including home health and skilled nursing facility policy and payment issues o Accountable Care Organizations o Federally-facilitated marketplace o Medicare Advantage o Various issues related to interoperable health information, including the post-acute care interoperability project (PACIO) o Medicare telehealth coverage under Part A and B o Provision and payment for Part A therapy o Various issues related to implementation of ACA o Issues related to Medicare beneficiaries accessing services provided by audiologists without a physician order o Issues related to qualified Medicare providers o Issues related to fraud, waste, and abuse Issues related to the Center for Medicare and Medicaid Innovation (CMMI) actions related to value-based care Issues related to proposals to block grant or institute work requirements and/or per capita caps in the Medicaid program.

Client expense: $290,000 · Firm income: Not reported

Government targets: Administration on Aging, Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), SENATE

Work on hospital issues affecting safety-net facilities including disproportionate share, Medicaid state directed payments and enhanced physician fee schedule payments.Monitor S. 5326, the Health Care Fraud Prevention and Enforcement Act.

Client expense: Not reported · Firm income: $40,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE