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Administrative Law Judge (ALJ) Administrative Appeals

Arnall Golden Gregory LLP

Healthcare Providers Could Finally Have Their Day in Court: Supreme Court Holds That Defendants Are Entitled to Jury Trials When...

On June 27, 2024, the Supreme Court of the United States released its opinion in SEC v. Jarkesy, a case involving a Securities and Exchange Commission (“SEC”) enforcement action for civil penalties against an investment...more

Maynard Nexsen

Proactive Coding Compliance: The Best Way to Avoid the CMS Administrative Appeal Process

Maynard Nexsen on

As an attorney specializing in healthcare reimbursement, I have focused my practice on helping healthcare providers navigate the Center for Medicare and Medicaid (“CMS”) administrative appeal process. I usually get a call...more

Morrison & Foerster LLP - Left Coast Appeals

This Week at the Ninth: Long Arms and Sore Backs

This week, the Ninth Circuit explains when courts have personal jurisdiction over foreigners who contract with U.S.-based businesses, and whether severe pain can qualify as a disability under the Longshore and Harbor Workers’...more

Baker Donelson

Recent Litigation Underscores Continued Difficulties with the 'Logjam' of the 'Colossal' Medicare Claim Appeals Backlog

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Although newly released data from the Office of Medicare Hearings and Appeals (OMHA) suggests that the Medicare claim appeals backlog might be decreasing, OMHA's case processing time and recent litigation challenging the...more

King & Spalding

Senators Grassley and Wyden Reintroduce Legislation to Reduce Medicare Appeals Backlog

King & Spalding on

On December 17, 2019, Senate Finance Committee Chairman Chuck Grassley (R-Iowa) and Ranking Member Ron Wyden (D-Ore.) reintroduced legislation to address the backlog of Medicare appeals cases awaiting review before an...more

Ogletree, Deakins, Nash, Smoak & Stewart,...

Supreme Court Places Another Limitation on Chevron Deference

The justices of the Supreme Court of the United States have again limited the reach of Chevron deference. On May 28, 2019, the Court in Smith v. Berryhill carved another exception into what has lately proven to be its...more

Faegre Drinker Biddle & Reath LLP

Supreme Court Decides Smith v. Berryhill

On May 28, 2019, the U.S. Supreme Court decided Smith v. Berryhill, holding a dismissal by the Social Security Administration’s Appeals Council on timeliness grounds after a claimant has had an administrative law judge...more

Hahn Loeser & Parks LLP

OSHRC’s Recent Ruling Provides Important Guidance on Limiting Controlling Employer Liability on Multi-Employer Worksites

On Feb. 1, 2019, the Occupational Safety and Health Review Commission (OSHRC) reversed an OSHA citation issued to Suncor Energy (U.S.A.) Inc., as the controlling employer, for a fall protection violation. In this ruling, the...more

Hahn Loeser & Parks LLP

OSHRC’s recent ruling provides important guidance for employers on heat exposure and the general duty clause

On Feb. 28 the Occupational Safety and Health Review Commission (OSHRC) reversed a citation issued to A.H. Sturgill Roofing, Inc. for the heat-related death of an employee, finding that all of the elements of proof of the...more

Snell & Wilmer

The Anatomy of an FTC Data Security Lawsuit

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The Federal Trade Commission (“FTC”) has described itself as “Your cop on the privacy beat” and a top federal regulator of consumer-facing data security practices. An example of how the FTC asserts itself when it comes to...more

Flaster Greenberg PC

Medicaid Caregiver Child Exemption Success Story in New Jersey: Home Saved & Nursing Home Paid

Flaster Greenberg PC on

Flaster Greenberg’s seasoned elder law attorney, Jane M. Fearn-Zimmer, obtained a landmark Medicaid Final Agency Decision for her elderly, ailing client and her family after a three-year long dispute with the New Jersey...more

Bass, Berry & Sims PLC

Judicial Opinions Support Delay of Recoupment from Audit Appeals Until After ALJ Hearings in Certain Circumstances

Bass, Berry & Sims PLC on

Recent opinions by the Fifth Circuit, the Northern and Southern Districts of Texas, and the District of South Carolina offer hope to providers seeking relief from substantial monetary recoupments during the Medicare appeals...more

Foley & Lardner LLP

CMS Recoupment Efforts Stopped by Court While Overpayment Appeals Are Pending

Foley & Lardner LLP on

Providers and suppliers who have been assessed overpayments for Medicare services are entitled, by statute, to a stay of recoupment while the provider or supplier’s appeal is pending – but only at the first two levels of...more

Jones Day

Texas Federal District Court Prevents Withholding of Medicare Payments

Jones Day on

In a much-anticipated decision in Family Rehab., Inc. v. Azar, Federal Judge Kinkeade enjoined the Centers for Medicare & Medicaid Services ("CMS") from withholding Medicare payments to effectuate the recoupment of the...more

Arnall Golden Gregory LLP

What’s Past Is Prologue: District Court Halts Medicare Recoupments After Fifth Circuit Rules That Courts Are Empowered to Halt...

Medicare’s implementation of post-payment review through overly aggressive private contractors, combined with an ineffective review process at the first two levels of the administrative appeal process (redetermination and...more

Dechert LLP

Appellate Court Directs FTC to Be More Specific in its Data-Security Orders

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In a closely watched data-security case, the U.S. Court of Appeals for the Eleventh Circuit vacated as unenforceable a cease and desist order issued by the U.S. Federal Trade Commission (FTC) against LabMD, Inc. According to...more

Baker Donelson

HHS Expands Settlement Conference Facilitation for Medicare Claims Appeals

Baker Donelson on

The Department of Health and Human Services (HHS) announced on November 3, 2017 additional settlement options for providers and suppliers in an effort to improve the Medicare claims appeals process, which included (1) the Low...more

Jones Day

Fifth Circuit Provides Relief for Providers Facing Medicare Appeal Backlogs

Jones Day on

The U.S. Court of Appeals for the Fifth Circuit has provided some relief to health care providers seeking to stop Medicare from "recouping" alleged overpayments before the provider can obtain a hearing before an...more

Baker Donelson

Court Finds Jurisdiction to Bar Recoupment Associated with Pending Claims Appeal

Baker Donelson on

On March 27, 2018, the United States Court of Appeals for the Fifth Circuit published an opinion that provides Family Rehabilitation, Inc. (Family Rehab) a second chance to postpone recoupment of about $7.6 million in...more

Arnall Golden Gregory LLP

Fifth Circuit: District Courts Have Jurisdiction to Halt Medicare Recoupments Pending Administrative Appeal to Prevent Procedural...

Medicare’s implementation of post-payment review through private contractors who are overly aggressive in denying payments, combined with an ineffective review process at the first two levels of administrative appeal...more

Parker Poe Adams & Bernstein LLP

Appeals Court Win Gives Providers Another Way to Challenge Medicare Appeals Backlog

A federal appeals court issued a significant ruling last week in relation to the ongoing backlog of Medicare claims appeals. It potentially gives providers a new way to seek relief when Medicare comes to collect money that an...more

Robinson+Cole Health Law Diagnosis

Fifth Circuit Reinstates Provider’s Collateral Challenge to the Medicare Appeal Process

On March 27, 2018, the United States Court of Appeals for the Fifth Circuit held that a health care provider can seek an injunction in federal court against recoupment by Medicare of alleged overpayments despite not...more

Arnall Golden Gregory LLP

D.C. Circuit Finds District Court Abused Discretion by Implementing a 4 Year Deadline to Clear Backlogged Administrative Appeals

On August 11, 2017, the D.C. Circuit issued its decision on the District Court’s order in American Hospital Association v. Price in a 2-1 decision, holding that the District Court abused its discretion by ordering the...more

Proskauer - Government Contractor Compliance...

Department Of Labor Challenges ALJ’s Decision On Google’s Obligation To Respond To OFCCP Data Requests

In July, we reported that an Administrative Law Judge (“ALJ”) had ruled on OFCCP’s dispute with Google over the tech giant’s refusal to turn over certain documents in connection with a routine audit of Google’s headquarters....more

Proskauer - Labor Relations Update

HR Generalist’s Threat To Bring In Union Not Protected, NLRB Rules

One of the most interesting things about labor relations is the unusual situations human resources professionals have to deal with on a day to day basis. If you are at a cocktail party with a human resources professional, ask...more

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