B. Scott McBride

B. Scott McBride


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Latest Posts › Hospitals


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 Healthcare Healthcare Providers Hospitals Medicaid Medicare Medicare Part A Medicare Part B Medicare Part D Overpayment Overpayment Recovery Time Limits

OIG Provides Additional Compliance Guidance for Healthcare Governing Boards

On April 20, 2015, the HHS Office of Inspector General (HHS OIG), in collaboration with the American Health Lawyers Association (AHLA), the Association of Healthcare Internal Auditors (AHIA), and the Health Care Compliance...more

4/27/2015 - Board of Directors Chief Compliance Officers Corporate Governance Health Care Providers Hospitals OIG

Aetna Out of Patience With Hospital’s Alleged Out-of-Network Billing Scheme

Aetna Life Insurance Company (Aetna) is going on the offensive against a Northwest Houston hospital with an out-of-network strategy. On February 23, 2015, Aetna filed suit in Texas federal court against Robert A. Behar, M.D....more

3/3/2015 - Aetna Excessive Fees Hospitals Insurance Litigation Out of Network Provider

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 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

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

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