B. Scott McBride

B. Scott McBride


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DOJ Takes Aim at Responsible Individuals in Corporate Investigations

U.S. Deputy Attorney General Sally Quillian Yates recently announced new instructions for attorneys at the U.S. Department of Justice (DOJ), outlining in a memorandum the DOJ’s policies with respect to civil and criminal...more

10/12/2015 - Best Practices Corporate Investigations DOJ Enforcement Actions False Claims Act (FCA) Federal Prosecutors Health Care Providers Healthcare Misappropriation Professional Misconduct Yates Memorandum

Texas Surgical Centers: Aetna Improperly Denies or Underpays Out-of-Network Claims

Aetna is now facing another set of claims calling into question its determination and payment methodology for out-of-network reimbursement. On September 4, 2015, six surgical centers in Texas (Allied Center for Special...more

9/29/2015 - Aetna Ambulatory Surgery Centers Denial of Benefits Denial of Insurance Coverage ERISA Health Care Providers Health Insurance Healthcare Insurance Industry Life Insurance Out-of-Pocket Expenses

Texas Hospital Strikes Back at Aetna

On February 23, 2015, Aetna filed suit in Texas federal court against Robert A. Behar, M.D. and North Cypress Medical Center (North Cypress), alleging that Dr. Behar, the CEO of North Cypress, offered impermissible ownership...more

8/31/2015 - Aetna Breach of Duty Contingency Fees ERISA Fiduciary Duty Healthcare Healthcare Fraud Hospitals Insurance Industry Lanham Act Life Insurance Malicious Prosecution Out of Network Provider Patient Referrals Real Party in Interest RICO Tortious Interference

Kane and the “60-Day Rule”: The Unforgiving World of Medicare and Medicaid Overpayments

The Southern District of New York has spoken on one of the first issues to confront those seeking compliance with the new “60-day rule” under the Affordable Care Act (ACA), and it does not bode well for defendant hospitals...more

8/14/2015 - Affordable Care Act CID Civil Investigation Demand CMS Compliance DOJ False Claims Act (FCA) Health Care Providers Healthcare Hospitals Medicaid Medicare Medicare Part A Medicare Part B Medicare Part D Overpayment Overpayment Recovery Time Limits

Supreme Court Decision Has Good News and Bad News for Those Facing False Claims Act Litigation

On May 26, 2015, the Supreme Court of the United States (SCOTUS) issued an opinion in a federal False Claims Act (FCA) case that resolves two important procedural points litigants face: the tolling of the six-year statute of...more

6/1/2015 - False Claims Act (FCA) First-to-File Health Care Providers Healthcare KBR (formerly Kellogg Brown & Root) Popular Qui Tam SCOTUS Statute of Limitations Whistleblowers WSLA

New Limitations on RAC Program

In March 2014, CMS temporarily suspended the Recovery Audit Contractor (RAC) program until it secured new contracts. The contracts for the program expired in June 2014, and in August, CMS said that it would restart the...more

1/22/2015 - CMS Healthcare Hospitals Medicare RAC Audits Recovery Audit Contractors (RACs)

CMS Offer Deadline to Settle Hospital Inpatient Claim Appeals Draws Near

In an attempt to clear the backlog of appeals of short inpatient stays, CMS recently announced a settlement offer for hospitals with claims currently pending in the appeals process. In exchange for withdrawal of their...more

10/6/2014 - CMS Healthcare Hospitals Inpatient Billing

Summer Fraud and Abuse Roundup

The federal government was busy over the summer when it came to decisions and settlements under the Stark Law, anti-kickback law and federal False Claims Act. This article revisits recent developments with respect to...more

8/25/2014 - Anti-Kickback Statute False Claims Act (FCA) Fraud and Abuse Healthcare Healthcare Fraud Settlement Stark Law Whistleblowers

OIG Revamps Regulations Concerning CMPs and Exclusion

In a pair of proposed rules published in May, the HHS OIG unveiled changes to the regulations concerning OIG’s authority to impose civil monetary penalties (CMPs) and exclude individuals and entities from participation in...more

6/3/2014 - Affordable Care Act Civil Monetary Penalty Employee Benefits Enforcement Exclusions Fraud and Abuse Healthcare OIG

CMS Announces Changes to RAC Program; Temporary Pause in Document Requests

The Centers for Medicare & Medicaid Services (CMS) recently published an announcement indicating that the agency is “in the procurement process for the next round of Recovery Audit Program Contracts” and is winding down its...more

3/7/2014 - CMS Document Requests Healthcare Healthcare Reform Recovery Audit Contractors (RACs)

HHS's Mixed Messages: Identifying a Federal Healthcare Program When You See It

Recent seemingly contrary determinations by the U.S. Department of Health and Human Services (HHS) have fueled industry speculation regarding whether qualified health plans (QHPs) available on the health insurance exchanges...more

11/15/2013 - Affordable Care Act Anti-Kickback Statute Fraud Health Insurance Exchanges Healthcare HHS Qualified Health Plans

CMS Addresses Hospital Rebilling After Inpatient Denials Through Interim Administrator Ruling and Proposed Rule

On March 18, the Centers for Medicare and Medicaid Services (CMS) published in the Federal Register two important documents addressing the hotly contested issue of a hospital's ability to obtain payment under Part B for...more

3/22/2013 - Billing CMS Denial of Benefits Healthcare Hospitals Medicare

Federal Healthcare Fraud Enforcement Efforts Yield a 790% Return

Last week, the U.S. Department of Health and Human Services (HHS) and the DOJ jointly released a report concluding that, for every dollar spent on healthcare fraud investigations in the last three years, the government...more

2/28/2013 - DOJ Healthcare Healthcare Fraud HHS

American Taxpayer Relief Act Amends Overpayment Recovery Time Limits

The ATRA significantly alters provider rights related to overpayment recoupment, refunds, audits and claims appeals. A provision entitled "Removing obstacles to collection of overpayments" increases the statute of limitations...more

1/16/2013 - American Taxpayer Relief Act Healthcare HHS Medicare OIG Overpayment Statute of Limitations

Health Law Update — January 10, 2013

In This Issue: - Healthcare Provisions in the American Taxpayer Relief Act - the Good, the Bad and the Ugly - American Taxpayer Relief Act Amends Overpayment Recovery Time Limits - OIG Advisory Opinion Sheds...more

1/14/2013 - American Taxpayer Relief Act CMS Data Breach Electronic Medical Records Fraud Healthcare OCR OIG Overpayment Recovery Time Limits Pay-for-Performance Reporting Requirements Settlement

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