Civil Procedure, Government Contracting, Health Law

OIG Releases Updated Provider Self-Disclosure Protocol

by John T. Bentivoglio, Jennifer L. Bragg, Maya Florence, Michael K. Loucks, Gregory M. Luce | Skadden, Arps, Slate, Meagher & Flom LLP on 5/21/2013

On April 17, 2013, the Office of the Inspector General (OIG) of the United States Department of Health and Human Services released an updated Provider Self-Disclosure Protocol (SDP). As self-described, OIG updated the SDP to...more

Sixth Circuit in MedQuest: No FCA Liability for Violation of Medicare Conditions of Participation Without Violation of Conditions...

by Calvin Marshall | Chambliss, Bahner & Stophel, P.C. on 4/26/2013

On April 1, 2013, the U.S. Court of Appeals for the Sixth Circuit overturned an $11.1 million False Claims Act (FCA) judgment by the U.S. District Court for the Middle District of Tennessee against MedQuest Associates, Inc.,...more

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

by Darby C. Allen, B. Scott McBride | BakerHostetler on 4/23/2013

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

Courts of Appeals Continue to Limit the Government’s Aggressive False Claims Act Theories

by Chelsey Hadfield, Ty Howard, Jack Selden | Bradley Arant Boult Cummings LLP on 4/23/2013

This spring saw two significant victories for health care providers in the federal courts of appeals. In both cases, the courts rejected an aggressive government theory under the False Claims Act (FCA), the first related to...more

Recent Changes Impact Appeal of Medicare Denials and Reimbursement Strategies

by Womble Carlyle Sandridge & Rice, PLLC on 4/17/2013

Recovery Audit Contractors (“RACs”) and other Centers for Medicare and Medicaid Services (CMS) contractors are charged with identifying overpayments made by Medicare to healthcare providers. However, with the increase in RAC...more

False Claims Act Focus - April 2013

by Mary Beth Bosco, Laurence Freedman, Michael Guiffre, Susan Baldwin Hendrix, Laura Laemmle-Weidenfeld | Patton Boggs LLP on 4/15/2013

EDITOR’S NOTE - The last few months have not failed to provide interesting False Claims Act (FCA) activity in the courts. We begin our newsletter by examining a case brought in the energy sector, alleging that a...more

PRRB Upholds Liquidation Requirement for Pension Expenses in Wage Index Calculation

by Mark A. Stanley | Ober|Kaler on 4/9/2013

The Provider Reimbursement Review Board (PRRB) has issued a decision upholding CMS’s policy of not recognizing pension expenses for purposes of calculating the wage index unless such expenses are liquidated within one year. ...more

Court of Appeals Rules for Government in DSH Exhausted Benefit Day Appeal

by Thomas W. Coons | Ober|Kaler on 4/5/2013

For the last several years, hospitals and the government have fought hard over where days associated with certain “dual eligible” patients should be placed in the Medicare disproportionate share hospital (DSH) calculation. At...more

Sixth Circuit Rules No FCA Liability Based on Violation of Medicare Requirements

by Ellyn L. Sternfield | Mintz Levin - Health Law on 4/4/2013

On April 1st, the Sixth Circuit reversed an $11.1 million dollar summary judgment finding entered against MedQuest Associates, a diagnostic testing company. In its opinion, the Sixth Circuit found that violation of two...more

D.C. District Court Again Rules That Bad Debt at a Collection Agency is Allowable

by Leslie Demaree Goldsmith | Ober|Kaler on 4/4/2013

The United States District Court for the District of Columbia recently ruled, again, that a Medicare contractor is not permitted to disallow Medicare bad debts solely on the ground that the bad debt is still at an outside...more

Resubmission of Hospital Claims

by Thomas Hess, Tyler N. Williams | Dinsmore & Shohl LLP on 3/13/2013

On February 13, CGS Administrators, the Parts A and B Medicare Administrative Contractor for Kentucky and Ohio, relayed instructions to Medicare hospitals paid under the Inpatient Prospective Payment System from the Centers...more

Payment Matters: No Judicial Review of Contractor’s Finding of a High Payment Error Rate, a Condition for Extrapolation

by Mark A. Stanley | Ober|Kaler on 2/11/2013

Before a Medicare contractor can use extrapolation to determine an overpayment amount, the Medicare statute requires that it must make a finding that there is a sustained or high level of payment error or that documented...more

Supreme Court Rules Equitable Tolling Cannot Be Used To Extend Deadline For Filing Medicare Part A Reimbursement Appeals

by Jeffrey Bates, Donald H. Romano, Chris Rossman, R. Michael Scarano Jr., Judith A. Waltz | Foley & Lardner LLP on 2/5/2013

On January 21, 2103, the U.S. Supreme Court unanimously held in Sebelius v. Auburn Regional Medical Center that the Medicare statute does not permit the time period for filing an appeal with the Provider Reimbursement Review...more

Payment Matters: Court Rules That Medicare DSH Statute Means What It Says

by Thomas W. Coons | Ober|Kaler on 1/25/2013

In recent times, the provider community has enjoyed success in challenging the Secretary’s interpretation of the Medicare disproportionate share hospital (DSH) adjustment provisions and what, the providers have maintained,...more

Payment Matters: AHA Survey Identifies Continuing Problems with Medicare RAC Program

by Mark A. Stanley | Ober|Kaler on 1/25/2013

The American Hospital Association (AHA) published its RACTRAC Survey results for the third quarter of 2012. The AHA created the survey in response to the lack of information released by CMS on its Medicare RAC program. For...more

Supreme Court Opinion in Sebelius v. Auburn Regional Medical Center Rejects a Challenge by Hospitals to Medicare's SSI Fraction...

by Stuart M. Gerson, Robert Wanerman | Epstein Becker & Green, P.C. on 1/25/2013

A unanimous Supreme Court has issued its opinion in Sebelius v. Auburn Regional Medical Center, No. 11-1231 (Jan. 22, 2013), rejecting a challenge by hospitals to Medicare's Supplemental Security Income ("SSI") fraction...more

Supreme Court Overturns Auburn Equitable Tolling Decision, 9-0

by King & Spalding on 1/24/2013

In Sebelius v. Auburn Regional Medical Center, No. 11-1231 (Jan. 22, 2013), the Supreme Court reversed a decision of the D.C. Circuit which had held that the 180-day time limit for hospitals to file a cost report appeal with...more

Fourth Circuit Holds False Claims Act Relators to Strict Pleading Standard: Ruling Will Be Particularly Useful in Defending...

by Ropes & Gray LLP on 1/23/2013

On January 11, 2013, the United States Court of Appeals for the Fourth Circuit issued an opinion reaffirming the requirement that False Claims Act relators plead presentment of a false claim with particularity. United States...more

A Reduction in the Utility of Civil Investigative Demands and the Interpretive Narrowing of "Person" under the False Claims Act

by Steve Cave | Womble Carlyle Sandridge & Rice, PLLC on 1/15/2013

Executive Summary: False Claims Act actions against government contractors are on the rise. But two recent decisions offer potential limitations to false claims exposure, and may aid defendants in future FCA litigation....more

Home

Legal News

Find a Lawyer

Browse Subjects

Subscribe

Pro Services

For Reporters

Civil Procedure › Government Contracting › Health Law