In That Case: Securities and Exchange Commission v. Jarkesy
#WorkforceWednesday® - SpaceX Victory: Court Questions NLRB's Constitutional Authority - Employment Law This Week®
Legal Alert | NLRB ALJ Finds Post Employment Non-Compete and Non-Solicit Provisions Unlawful
The Labor Law Insider - NLRB Remedies: “Draconian” Says the Fifth Circuit Court of Appeals in Thryv
AGG Talks: Home Health & Hospice - Lessons Learned From ALJ Hospice Audit Appeals
After ALJ: Options and Opportunities in the Face of an Unfavorable ALJ Decision
Hospice Audit Series | Welcome to the Party: Contractor Participation at ALJ Hearings
The Justice Insiders: The Administrative State is Not Your Friend - A Conversation with Professor Richard Epstein
Four Decision Points in SEC Securities Investigations
DE Under 3: Reversal of 2019 Enterprise Rent-a-Car Trial Decision; EEOC Commissioner Nominee Update; Overtime Listening Session
DE Under 3: New NLx Job Count Record; Fifth Circuit Court of Appeals Big Strike Down; OFCCP’s Latest CSAL
Tribal Tax Exemption Under McGirt Gains Preliminary Victory
Hospice Audit Series: Insights for Winning at Administrative Law Judge (ALJ) Hearings, Part II
Hospice Audit Series: Insights for Winning at Administrative Law Judge (ALJ) Hearings, Part I
Hospice Audit Series: How are Hospices Faring at ALJ Hearings?
A Look Ahead at the Biden Administration’s Regulatory and Enforcement Priorities
U.S. International Trade Commission
II-34- Ten Things You Missed From Summer 2018
Our firm is seeing an uptick in Medicare demand letters for the recovery of overpayment for skin substitutes, such as WoundFixTM, Biobrane, Dermagraft®, AmnioBand®, or AlloPatch®, used in the treatment of wounds. CMS auditors...more
In a recent decision, the Northern District of Texas, Dallas Division, granted a health care provider a preliminary injunction to prevent the Centers for Medicare & Medicaid Services ("CMS") from withholding Medicare payments...more
HHS’s Office of Medicare Hearings and Appeals (OMHA) has long faced a backlog in Medicare appeals to Administrative Law Judges (ALJs). In an effort to address this backlog, OMHA established a Settlement Conference...more
This year CMS is rolling out two new programs aimed, finally, at helping to settle certain types of pending provider reimbursement appeals. The programs are the Low Volume Appeals Initiative and Settlement Conference...more
On January 9, 2018, the Centers for Medicare and Medicaid Services (CMS) announced details on the new low volume appeal settlement option, which is the latest alternative available to Medicare Part A and Part B providers and...more
For years the hospital industry has been in an uproar over the mountainous backlog of Medicare claim appeals. Current estimates are that a whopping 650,000 claims are at the Administrative Law Judge level awaiting...more
Over the past decade, health care providers seeking to challenge Medicare claim denials have faced increasing delays in reaching what many consider the most important step in the Medicare appeals process - a hearing before an...more
On Feb. 25, 2016, the Office of Medicare Hearings and Appeals (OMHA) conducted a teleconference to address Phase III of the Settlement Conference Facilitation (SCF) project, which also became effective on Feb. 25, 2016. SCF,...more
On October 15, 2015, the Office of Medicare Hearings and Appeals (“OMHA”) conducted a teleconference to address Phase II of the Settlement Conference Facilitation (“SCF”) Pilot, effective October 1, 2015. SCF, launched in...more
In keeping with the trend to strengthen its authority to deny an enrollment or revoke Medicare billing privileges, CMS has modified the appeals process in a manner that will significantly shorten the time allotted to mount an...more
For providers who have received inconsistent or varying reasons for denial while navigating through the Medicare appeals process, the Centers for Medicare & Medicaid Services (CMS) has provided much-needed relief in the form...more
On June 3, 2015, the Senate Finance Committee passed an original bill that aims to streamline and improve the Medicare Audit and Appeals Process. The Medicare appeals process has recently faced scrutiny from industry leaders...more
CMS officially added a new Section 3.9 to the Medicare Program Integrity Manual, effective October 27, 2014. These provisions instruct Medicare Administrative Contractors (MACs) to assign a physician to participate at...more
The Office of Medicare Hearings and Appeals (OMHA), which oversees the Administrative Law Judge (ALJ) level of appeal, recently posted two important announcements regarding a new Statistical Sampling Initiative (SSI) and...more
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
The OIG recently published a report reviewing the implementation of 2005 regulations regarding the administrative law judge (ALJ) level of appeals, the third level of the Medicare appeals system. The 2005 regulatory changes...more