B. Scott McBride

B. Scott McBride

BakerHostetler

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Sixth Circuit Holds Physician Supervision and Enrollment Issues Are Not Conditions of Payment for Purposes of FCA Liability

The Sixth Circuit Court of Appeals recently issued a decision overturning an $11.1 million False Claims Act (FCA) verdict against MedQuest Associates, Inc. (MedQuest) for submitting claims to Medicare in violation of the...more

4/23/2013 - False Claims Act Medicare MedQuest Physician Payments Physicians Supervision

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

Annual Report Shows Meteoric Rise in RAC Activity

On February 5, 2013, CMS issued its mandatory Recovery Audit Contractor (RAC or Recovery Auditor) program annual report, detailing overpayments, underpayments, RAC performance and savings to the Medicare program. According to...more

2/27/2013 - ALJ Audits CMS Medicare Overpayment Recovery Audit Contractor

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 Without Fault Provisions

ALJ Appeals Frequently Favorable To Providers; OIG Calls For Reforms

The OIG recently published a report reviewing the implementation of 2005 regulations regarding the administrative law judge (ALJ) level of appeals, the third level of the Medicare appeals system. The 2005 regulatory changes...more

12/11/2012 - ALJ Appeals CMS Medicare OIG

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