Do You Have a Backup? Building Redundancies Into Your Written Certification Process
Top Employment Law Considerations for Startups, with Ashley K Pittman
Prompt Payments: How CASPA and Other State Laws Afford Contractors Protections
Coronavirus, An Unforeseeable Circumstance: Does Your Contract Protect You Under Force Majeure Clauses?
Coronavirus Employment Law Update for Contractors (New Jersey)
Coronavirus Employment Law Update for Contractors (Pennsylvania)
Employment Law This Week®: FAA Arguably Preempts California Law, New CA Employment Laws for 2020, CA Consumer Privacy Act Amended
Is My New Hire an Employee or a Contractor? Key Factors for Startups to Consider
Episode 25: 10 Factors That May Hinder a Contractor’s Ability to Repay Its Bank Loans and Threaten Its Existence
Common Missteps When Suing the State of New Jersey and How to Prevent Them
[WEBINAR] Labor & Employment Law: What Changed in 2017
Teaming Arrangements: Pros and Cons of Teaming Agreements vs. Joint Ventures
Suspension and Debarment
Employment Law This Week®: EEOC Online Public Portal, Paid Sick Leave Preemption Law, DOL to Appeal Texas Ruling, California Law Makes Contractors Jointly Liable for Their Subs’ Unpaid Wages
Award Protests: Choosing the Forum
Federal Cybersecurity Requirements
How to Assess the Likelihood of Success in Deciding Whether to Bring a Bid Protest
Construction Lien Law: What You Need to Know to Protect Your Company
Homebuilder Series Webinar: Protecting Your Company From Misrepresentation Claims Through Contractual Exculpatory Clauses
Parties litigating False Claims Act (FCA) cases have long struggled with a thorny question around the essential element of scienter (the defendant’s intent, or state of mind): What/how much does a contractor need to know when...more
The hospice certification of terminal illness is one of the documents most scrutinized by Medicare contractors, and it is of critical importance since an invalid certification can impact Medicare payment for the patient’s...more
OIG Warns That Proposed Drug Discounts May Warrant Sanctions - On October 5, the US Department of Health and Human Services’ Office of Inspector General (OIG) issued an advisory opinion assessing a proposal that involved...more
CEO of Defunct Medical Testing Lab to Pay $1.1 Million to Settle FCA and AKS Case - Jae Lee, the former CEO of defunct Northwest Physicians Laboratory (NWPL), agreed to pay $1.1 million to resolve allegations that he...more
The Centers for Medicare & Medicaid Services (CMS) recently issued Advisory Opinion No. CMS-AO-2021-01, clarifying that physician groups that furnish designated health services (e.g., laboratory, imaging) through wholly-owned...more
Medical reviews to restart- The Centers for Medicare & Medicaid Services (CMS) medical review activity suspended due to COVID-19 is set to restart on August 3, 2020, regardless of the public health emergency status....more
The Government Accountability Office (GAO) has released the findings of its study of the steps taken by CMS to prevent Medicare contractors from conducting certain duplicative post-payment claims reviews. Based on its audit,...more
Under the controversial program private contractors audit hospitals and other Medicare providers for fraudulent and erroneous Medicare billing. Why is it controversial? Because the auditors are paid a percentage of...more
The Centers for Medicare and Medicaid Services (CMS) of the Department of Health and Human Services recently issued Transmittal 505 modifying Section 3.2.3 of the Medicare Program Integrity Manual. CMS employs a variety of...more
Effective March 6, 2014, Medicare contractors may automatically deny claims that are “related” to other claims that have been denied as a result of pre- or postpayment review. Contractors need not issue Additional...more
On February 12, 2014, the U.S. Court of Appeals for the Third Circuit held that Federal courts do not have jurisdiction to review HHS’s determination of a “sustained or high level of payment error,” one of two possible...more
On August 22, the U.S. Government Accountability Office (GAO) released a report calling for the Centers for Medicare & Medicaid Services (CMS) to improve the efficiency and effectiveness of its Medicare program integrity...more
The U.S. Government Accountability Office (GAO) recently published the results of a study examining the effectiveness of CMS’s contractors that conduct postpayment claims reviews to identify improper payments (i.e., Medicare...more
On August 7, 2013, the Centers for Medicare & Medicaid Services (CMS) published in the Federal Register1 a notice that updated the processes that CMS uses for opening, deciding or reconsidering National Coverage...more
In a decision handed down on July 23, 2013, the United States Court of Appeals for the D.C. Circuit upheld the use by CMS of outside contractors to determine whether a home health agency’s reimbursement claims had exhibited a...more
CMS recently announced plans to implement a new Medicare and Medicaid program integrity contractor, Unified Program Integrity Contractors (UPICs). ...more
King & Spalding recently hosted a Roundtable Webinar focused on CMS Ruling 1455-R and Proposed Rule 1455-P. Both of these developments are of great interest to the healthcare industry because they have a significant impact on...more
One of King & Spalding’s clients reported to us that its Medicare contractor had not correctly calculated the 2 percent sequestration reduction in payments for purposes of biweekly pass-through payments. ...more