Lawrence Vernaglia

Lawrence Vernaglia

Foley & Lardner LLP

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Will CMS’s Proposed Rule on “Identified Overpayments” Increase Reverse FCA Cases?

On December 27, 2022, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule which, in part, seeks to amend the existing regulations for Medicare Parts A, B, C, and D regarding the standard for when an...more

1/3/2023  /  Affordable Care Act , Centers for Medicare & Medicaid Services (CMS) , Civil Monetary Penalty , Department of Health and Human Services (HHS) , Department of Justice (DOJ) , False Claims Act (FCA) , Medicare Advantage , Medicare Part A , Medicare Part B , Medicare Part C , Medicare Part D , OIG , Overpayment , Proposed Rules

Cardiac Medical Device Medicare Overpayment Self-Assessment – Methodology

More than 900 hospitals across the United States are approaching a Centers for Medicare & Medicaid Services (CMS)-imposed deadline to report overpayments from the removal (explant) of defective cardiac medical devices if...more

7/19/2021  /  Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Medical Devices , Medicare , Medicare Administrative Contractors (MAC) , OIG , Overpayment , Product Defects

The Who, What, and When for the CMS Final 60-Day Rule

Four years after the issuance of the Proposed Rule and six years after the authorizing statute, CMS has published the much-awaited Final Rule regarding reporting and returning of Medicare Part A and B overpayments (the “Final...more

2/18/2016  /  60-Day Rule , Affordable Care Act , Centers for Medicare & Medicaid Services (CMS) , Final Rules , Medicare Part A , Medicare Part B , Overpayment

Fasten Your Seat Belts: District Court Says “Failure to Act Quickly Enough” May Violate 60-Day Refund Rule

A New York Federal District Court issued an Opinion and Order, on August 3, 2015, in a closely-watched False Claims Act (FCA) case, Kane v. Healthfirst, Inc. The Court refused to dismiss the whistleblower complaint in which...more

8/12/2015  /  Affordable Care Act , False Claims Act (FCA) , Health Care Providers , Hospitals , Internal Investigations , Medicaid , Medicare , Overpayment , Whistleblowers

CMS Delays Publication of Final Rule Regarding Reporting and Returning of Medicare Overpayments

One of the most challenging compliance changes brought about by the Affordable Care Act (ACA) is the provision mandating the reporting and refunding of Medicare and Medicaid overpayments within 60 days of the date they are...more

3/10/2015  /  Affordable Care Act , Centers for Medicare & Medicaid Services (CMS) , Medicaid , Medicare , Overpayment , Overpayment Recovery Time Limits , Reporting Requirements

Medicare’s 60-Day Proposed Refund Rule Imposes Significant Liability on Providers

As part of the Affordable Care Act, Congress outlined the process for providers to return Medicare and Medicaid overpayments. In 2012, CMS proposed the 60-day Refund Rule, as it is commonly known, requiring Medicare providers...more

4/17/2014  /  Affordable Care Act , Centers for Medicare & Medicaid Services (CMS) , Look-Back Measurement Period , Medicaid , Medicare , Overpayment , Refunds , Reimbursements
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