Government Contracting › Administrative Law

Recent Changes Impact Appeal of Medicare Denials and Reimbursement Strategies

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

Resubmission of Hospital Claims

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

OFCCP Rescinds Old Compensation Guidance, Implements New Compensation Directive

On February 28, 2013, the U.S. Department of Labor's Office of Federal Contract Compliance Programs (OFCCP) rescinded two enforcement guidance documents on pay discrimination from 2006 and replaced them with a new Directive...more

Federal Healthcare Fraud Enforcement Efforts Yield a 790% Return

Last week, the U.S. Department of Health and Human Services (HHS) and the DOJ jointly released a report concluding that, for every dollar spent on healthcare fraud investigations in the last three years, the government...more

MACAU ADOPTS NEW RULES APPLICABLE TO THE SUPPLY OF SLOT MACHINES AND RELATED EQUIPMENT

Macau Government has enacted new rules concerning gaming manufacturers' approval to supply slot machines in Macau. The new Administrative Regulation 26/2012 contains rules relating to the licensing procedure for gaming...more

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

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

Payment Matters: Supreme Court: Providers' Appeal Period Not Extended by Doctrine of Equitable Tolling

Under the Medicare statute and implementing regulation, providers have 180 days from the issuance of a Notice of Program Reimbursement (NPR) in which to file an appeal to the Provider Reimbursement Review Board (PRRB). This...more

Smash & Grab Redux - Congress Seems to Give DCAA Permission But Forgets to Give It Authority

Last month we wrote about a provision in the proposed 2013 National Defense Authorization Act (“NDAA”) that would have given the Defense Contract Audit Agency (“DCAA”) statutory authority to demand a company’s internal audit...more

Shell E & P Ireland Ltd v McGrath & ors

Judgement in Shell E & P Ireland Ltd v McGrath & ors

2.1 Shell issued proceedings against the six named defendants on the 4th March, 2005 with a statement of claim being delivered on the 18th April. Damages were sought together with various orders restraining the defendants...more

OIG: Cardiac Catheterization Arrangement Between Hospital and Physicians Not Subject to Sanctions

On January 7, 2013, HHS OIG published a favorable advisory opinion on a management arrangement between a hospital and a cardiology group related to the provision of certain cardiac catheterization services at the hospital. ...more

What To Do If The Feds Come Knocking At Your Door!

Your employee handbook likely addresses, in great detail, the do's and don'ts of using the internet while at the office, guidance on HIPAA, and even the company's policy on sexual harassment, but does it provide any...more

Health Reform + Related Health Policy News Update - January 16, 2013

In This Issue: - Fiscal Cliff Deal Lengthens Medicare Overpayment Recovery Period - Cutting Medicaid Provider Tax May Shift Costs to States, CRS Finds - MedPAC Finalizes Payment Recommendations, GAO Solicits...more

Chinese MOH Announced Centralized Procurement of High Value Medical Consumables

On December 17, 2012, the Ministry of Health (“MOH”) issued the Tentative Guidelines for Centralized Procurement of High Value Medical Consumables (the “Guidelines”) with immediate effect, with an aim to control health care...more

Payment Matters: Extension of Time for Overpayment Recoveries in Fiscal Cliff Law Not as Broad as it Sounds

The recently passed fiscal cliff legislation, i.e., the American Taxpayer Relief Act of 2012 (Act) [PDF], includes a number of provisions addressing Medicare and Medicaid. One of these provisions extends the recovery period...more

BuildSouth: Considering Construction Delivery Methods On Public Works

Originally Published In BUILDSouth, Winter 2013. Historically, in Alabama, the project delivery methods available for owners to de-sign and construct private projects have differed from those delivery methods available...more

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

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

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

2012-13 Education Legislation Summarized By KMTG

In order to have the new 2012-13 education legislation handy, we have combined our series on the subject into one easy to reference location. Here you will find a recap of all the legislation we summarized, along with a link...more

CMS Seeks Comments on Hospital Readiness for EHR Hospital Inpatient Quality Data Reporting

CMS is seeking comments from hospitals, electronic health record (EHR) vendors, and other interested parties regarding whether hospitals could be ready as early as January 1, 2014, to electronically report patient-level...more

2013 Enforcement Predictions

I always like to make predictions at the beginning of each year. My track record is plus and minus – sometimes on target, sometimes off-target. The biggest story in the last five years has been the rise of FCPA...more

Audits, Audits And More Audits: Life In The Healthcare Industry

Healthcare suppliers and service providers live in a regulated world. They are constantly under audit scrutiny. Sometimes federal agencies (i.e private contractors) conduct the audits; other times state agencies conduct the...more

HB16 Would Make Significant Changes to Economic Development in Alabama

Representative Patricia Todd (D-Birmingham) has introduced HB16, the Alabama Economic Development and Fiscal Accountability Act, for the upcoming legislative session that would make substantial changes to economic development...more

Pennsylvania's P3 Implementation Manual: An Overview

On January 9, 2013, the Pennsylvania Public-Private Transportation Partnership Board (P3 Board) approved the Implementation Manual for Solicited and Unsolicited Projects (Implementation Manual), which provides highly...more

Effective January 2013: Ordering- and Referring-Only Providers Must Enroll in Texas Medicaid

Texas Medicaid providers that receive referrals from non-participating physicians or other health care providers need to beaware that beginning January 1, 2013, individual providers who arenot currently enrolled in Texas...more

Florida-Based Company Settles False Claims Act Lawsuit For $15.3 Million

The Department of Justice (DOJ) has announced that Jacksonville, Florida-based American Sleep Medicine LLC has settled allegations that it fraudulently billed Medicare, TRICARE (the health care program for uniformed...more