Scot Hasselman

Scot Hasselman

Reed Smith

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CMS Still Finding Its Way Through Significant Medicare Appeals Backlog – Proposes New Rule in an Effort to Catch Up

In the proposed rule, CMS focuses on taking administrative actions to alleviate the backlog, including introducing the concept of precedential decisions, delegating certain administrative law judge tasks to “attorney...more

8/10/2016 - Admissible Evidence ALJ CMS Health Care Providers Judicial Review Medicare Medicare Appeals Council Medicare Claims Appeals Process OMHA Precedential Opinion Proposed Regulation

Bigger Apparently is Better in DOJ’s Eyes – DOJ Piles On as False Claims Act CMPs Set to Almost Double on August 1, 2016

On June 30, 2016, the Department of Justice published an interim final rule with request for comments that applies an inflation adjustment to civil monetary penalty (CMP) amounts assessed by the Department, as mandated by the...more

6/30/2016 - Bipartisan Budget Civil Monetary Penalty Comment Period Corporate Counsel DOJ False Claims Act (FCA) Health Care Providers Interim Rule Manufacturers Suppliers

CMS Eases 60-Day Overpayment Requirement in Final Rule While Raising New Questions

On February 11, 2016, the Centers for Medicare & Medicaid Services (“CMS”) released the long awaited final rule clarifying the statutory requirement under the Affordable Care Act for providers and suppliers to report and...more

2/12/2016 - 60-Day Rule Affordable Care Act CMS Final Rules Medicare Part A Medicare Part B Overpayment

Identification of Overpayments: A Win for DOJ Cautions 'Prosecutorial Discretion' in Enforcement of an 'Unforgiving Rule'

On August 3, 2015, the Southern District of New York issued the first judicial opinion interpreting the Affordable Care Act’s “60-Day Overpayment Rule” in a False Claims Act (“FCA”) case. In a clear win for the Department of...more

8/19/2015 - 60-Day Rule Affordable Care Act CMS DOJ False Claims Act (FCA) Hospitals Overpayment

Analysis of HHS OIG Proposed Rule to Amend the Anti-Kickback Safe Harbors, CMP Rules on Beneficiary Inducements & Gainsharing...

On October 3, 2014, the Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) published a major proposed rule that would amend the safe harbors to the Anti-Kickback Statute (AKS) and the Civil...more

10/22/2014 - Affordable Care Act Ambulance Providers Anti-Kickback Statute CMP Law Gainsharing Hospitals OIG Pharmacies Physicians Proposed Regulation Public Comment Rulemaking Process Safe Harbors

HHS OIG Proposes Rule to Expand Exclusion Authorities

On May 9, 2014, the Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) published a proposed rule that would significantly expand the exclusion regulations applicable to persons or entities...more

5/19/2014 - Administrative Authority Affordable Care Act Exclusions Healthcare HHS Hospitals OIG Proposed Regulation Provider Payments Statute of Limitations

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