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Administrative Law Judge (ALJ) Health Care Providers

Arnall Golden Gregory LLP

Government Investigations Team Insights - July 2024

AGG’s Government Investigations Team Insights provides periodic updates covering legal and regulatory topics. Our team, which includes former federal prosecutors, SEC enforcement attorneys, and federal agency attorneys, has...more

Arnall Golden Gregory LLP

AGG Talks: Home Health & Hospice - Lessons Learned From ALJ Hospice Audit Appeals

In this episode, AGG Post-Acute & Long-Term Care co-chair Jason Bring is joined by Megan Turby and Lisa Barker, MD, of Gulfside Healthcare Services in Land O' Lakes, Florida. AGG represented Gulfside in a series of hospice...more

Littler

(Not So) Frozen in Time—Colorado District Court Enters Section 10(j) Order Preventing Hospital from Withholding Across-the-Board...

Littler on

On November 16, 2023, a federal court in Colorado issued a lengthy opinion granting in part a petition for a temporary injunction pursuant to Section 10(j) of the National Labor Relations Act (the “Act”). Lomax v. Longmont...more

Morgan Lewis - Health Law Scan

Hospice Alert: Making Sense of New OMHA Administrative Law Judges

If your organization has faced a Medicare audit in the last decade, you may have experienced a significant delay in the Medicare appeals process due to a monumental backlog of claims pending in front of administrative law...more

Husch Blackwell LLP

Hospice Audit Series | Welcome to the Party: Contractor Participation at ALJ Hearings

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Recently, there has been an uptick in contractor participation at the ALJ stage of hospice audit appeals. This development poses unique challenges and new advocacy opportunities for providers. In this episode, Husch...more

Husch Blackwell LLP

Hospice Audit Series: Insights for Winning at Administrative Law Judge (ALJ) Hearings, Part II

Husch Blackwell LLP on

In Part II of our two-part series on ALJ hearings, Husch Blackwell’s Meg Pekarske unpacks strategies for winning with colleagues Bryan Nowicki, Emily Solum and Erin Burns. They explore what it means to be well-prepared and...more

Husch Blackwell LLP

Hospice Audit Series: Insights for Winning at Administrative Law Judge (ALJ) Hearings, Part I

Husch Blackwell LLP on

In this two-part series, Husch Blackwell’s Meg Pekarske unpacks strategies for winning at ALJ hearings with colleagues Bryan Nowicki, Emily Solum and Erin Burns. They explore what it means to be well-prepared and who should...more

Hinshaw & Culbertson - Health Care

California Appellate Court Rules Federally Qualified Health Center Outreach Expenses Don't Qualify For Cost-Based Reimbursement

Family Health Centers of San Diego (Health Center) operates a federally qualified health center (FQHC) that has 49 locations throughout San Diego County, California, and provides a comprehensive range of primary and...more

Akerman LLP - Health Law Rx

Decision Reminds Providers of Limits on Restricting Employee Communications with Media

Hospitals and medical groups that bar staff from communicating with the media should take another look at those prohibitions following a recent federal appellate decision finding such a policy unlawful under the National...more

Husch Blackwell LLP

Hospice Audit Series: How are Hospices Faring at ALJ Hearings?

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After waiting years, hospices are getting their “day in court.” How are hospices faring? In this episode, Husch Blackwell’s Meg Pekarske is joined by colleagues Bryan Nowicki and Emily Park, who share insights on what it...more

Health Care Compliance Association (HCCA)

Provider Wins $2M Appeal at ALJ Over Modifier 25, Random Sample

Report on Medicare Compliance 30, no. 11 (March 22, 2021) - A cancer center has won its appeal of $2 million in Medicare claim denials in a case about modifier 25 and the extrapolation of an overpayment. Problems with the...more

Latham & Watkins LLP

A Look Ahead at the Biden Administration’s Regulatory and Enforcement Priorities

Latham & Watkins LLP on

With the new administration poised to take office, public and private companies will need to consider how President Biden’s regulatory, enforcement, and legislative priorities will affect their businesses. During this...more

Oberheiden P.C.

Is Your Medical License at Risk? What Doctors Need to Know about ALJ Hearings

Oberheiden P.C. on

As a doctor, allegations of medical malpractice or other unlawful or unethical conduct can have wide-ranging implications. In addition to facing civil liability and the prospect of a significant increase in your medical...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

Health Care Compliance Association (HCCA)

DAB Affirms OIG's $1.32M Penalty on Provider for Breaching CIA

Report on Medicare Compliance 29, no. 23 (June 22, 2020): The HHS Departmental Appeals Board (DAB) has upheld the largest stipulated penalty imposed by the HHS Office of Inspector General (OIG) in years. OIG fined...more

Arnall Golden Gregory LLP

Nursing Facilities Obtain Increase of Fair Rental Value Rates

During 2018, five nursing facilities sought to create a more livable space for their residents by reducing their licensed bed capacities. These changes eliminated 3-bed wards in favor of semi-private rooms and improved living...more

Arnall Golden Gregory LLP

CMS Expands Authority to Revoke Providers’ Medicare Enrollment While Medicare Overpayment Appeals are Pending ALJ Review

On September 10, 2019, the Centers for Medicare and Medicaid Services (CMS) announced new authority to revoke providers’ Medicare enrollment and any corresponding provider agreements or supplier agreements through revisions...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

Faegre Drinker Biddle & Reath LLP

Hospital Price Transparency Final Rule

The Centers for Medicare and Medicaid Services (CMS) published the Price Transparency Requirements for Hospitals to Make Standard Charges Public Final Rule (the Final Rule, effective January 1, 2021), in the Federal Register...more

Arnall Golden Gregory LLP

Two Recent Federal Court Decisions Split on Family Rehabilitation Precedent: Fifth Circuit May Once Again Determine Providers’...

Two United States District Courts in Louisiana and Illinois issued split decisions within two weeks of each other on the dire financial issues facing providers every day under the discretionary “penal recoupment” system the...more

Kramer Levin Naftalis & Frankel LLP

Fifth Circuit Joins Circuit Split Upholding Bankruptcy Court Jurisdiction to Hear Social Security Claims: Case Has Impact for...

In a case that could impact health care bankruptcies, where jurisdiction over Medicaid and Medicare claims in bankruptcy are often disputed, the Fifth Circuit, in In re Benjamin v. U.S. Social Sec. Admin., Case No. 18-20185,...more

Sheppard Mullin Richter & Hampton LLP

Hospice False Claims: AseraCare Lost A Battle But Has Helped Win The War

Last week, the 11th Circuit Federal Court of Appeals reversed summary judgment given to AseraCare in its hospice false claims case, setting up more litigation on the question whether AseraCare’s certifications were made in...more

Bradley Arant Boult Cummings LLP

Alabama CON Report - August 2019

Bradley presents our August 2019 Alabama CON Review Board Update, prepared for the firm's healthcare clients and other interested parties. The firm's Certificate of Need practice utilizes a cross-disciplinary team approach,...more

Arnall Golden Gregory LLP

Texas Court Holds That Medicare Payment Suspensions Cannot Be Challenged In Federal Court

When the Centers for Medicare and Medicaid Services (CMS), through a Medicare contractor, conducts a post-payment audit of a provider’s Medicare reimbursements and determines that the provider may have received an...more

Arnall Golden Gregory LLP

Good News for Medicare Providers as CMS Expands Settlement Conference Facilitation and Introduces New Initiative for IRFs

The Centers for Medicare and Medicaid Services (CMS) made a number of recent changes to expand the Settlement Conference Facilitation (SCF) process for providers and suppliers mired in the backlog of appeals at the...more

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