Medicaid, False Claims Act (FCA), Overpayment Recovery Time Limits

FCA Settlement Alert: Physician Compliance with CMS’ 60-Day Overpayment Rule

Williams Mullen on 11/9/2017

On October 13, 2017, the U.S. Attorney’s Office for the Middle District of Florida announced a settlement for over $440,000 with First Coast Cardiovascular Institute, P.A. (“First Coast”), a large cardiovascular physician...more

Reminder: Medical Providers Must Be Attentive to Credit Balances and Other Overpayments

Chambliss, Bahner & Stophel, P.C. on 8/23/2017

It has now been a number of years since the enactment of Section 6402(a) of the Affordable Care Act ("ACA"), which requires among other things that any recipient of a Medicare or Medicaid overpayment report and return it...more

2016 Health Care Year in Review

Burr & Forman on 12/12/2016

Since I began writing this year-end review in 2013, there have been some common themes – a shift to pay for quality and away from fee-for service, much of which has been brought about by the Affordable Care Act (ACA): efforts...more

60-Day Overpayment FCA Enforcement Action Results in $2.95 Million Settlement

King & Spalding on 8/30/2016

On August 23, 2016, a New York hospital system settled False Claims Act (FCA) allegations that it violated the 60-day overpayment rule by improperly retaining Medicaid overpayments. The whistleblower alleged that three of the...more

The Overpayment Rule and the Implied False Claims Theory: “What You Don’t Know Can Still Hurt You”

Sheppard Mullin Richter & Hampton LLP on 7/14/2016

In 2010, the Affordable Care Act (“ACA”) enacted new rules governing overpayments made by the Medicare and Medicaid programs. Under these rules, providers have 60 days from the date that the overpayment has been identified to...more

Tick, Tock, Shock: CMS Provides Welcome Guidance in the Final Regulation for 60-Day Rule

Davis Wright Tremaine LLP on 2/16/2016

On Feb. 12, 2016, CMS published the much anticipated final regulations implementing the so-called “60-Day Rule.” Congress adopted the 60-Day Rule as part of the Affordable Care Act (ACA). The Rule requires health care...more

New CMS rule clarifies when 60-day overpayment clock starts ticking

Akerman LLP - Health Law Rx on 2/16/2016

Four years after publication of its proposed rule related to reporting and returning overpayments within 60 days, CMS has issued a final rule that responds to comments and provides greater clarity. The published rule is under...more

Identifying Overpayments Under the ACA’s 60-Day Rule Creates Additional Uncertainty in Determining False Claims Act Liability

Akerman LLP - Health Law Rx on 11/6/2015

Under the Affordable Care Act (ACA), healthcare providers that receive an overpayment from Medicare or Medicaid are required to report and return the overpayment to the government within 60 days after the date on which the...more

Health Law Pulse - October 2015

Robinson & Cole LLP on 10/8/2015

The Health Resources and Services Administration (HRSA) recently issued proposed omnibus guidance (Omnibus Guidance) interpreting various provisions of the 340B Drug Pricing Program (340B Program). The 340B Program allows...more

Recent Cases Involving 60-Day Overpayment Rule Should Put Healthcare Providers on Alert

Lowndes on 10/1/2015

Two recent federal court cases show that the federal government intends to vigorously enforce the so-called “60-day Rule” for the return of overpayments enacted as part of the Affordable Care Act (the “ACA”) even though the...more

The 60 Day Rule — Identification and Knowing Avoidance

Ballard Spahr LLP on 8/26/2015

On August 3, 2015, the United States District Court for the Southern District of New York issued an opinion and order in Kane v. Healthfirst, Inc., et al.[1] that provides the first judicial interpretation of the requirement...more

Federal Court Rejects Health System's Efforts to Dismiss 60-Day Rule Suit

Robinson & Cole LLP on 8/21/2015

On August 3, 2015, the United States District Court in the Southern District of New York issued a long-awaited opinion and order rejecting a motion to dismiss filed by the defendants in U.S. ex rel. Kane v. Continuum Health...more

Compliance: Reporting Overpayments and the 60-day Clock

Benesch on 8/20/2015

On August 3, 2015, a federal judge in New York issued an important opinion regarding the False Claims Act and what it means to “identify” an overpayment for purposes of starting the 60-day clock in which Medicare and Medicaid...more

Court Imposes Potentially Unworkable Burden on Providers Under ACA's Report and Return Rule

Baker Donelson on 8/20/2015

In Kane ex rel. U.S. v. Healthfirst, Inc., the federal district court for the Southern District of New York (District Court or Court) provided on August 3 the first and long-awaited interpretation as to when a health care...more

Federal District Court Interprets 60-Day Overpayment Rule Trigger

King & Spalding on 8/18/2015

In an eagerly anticipated decision issued on August 3, 2015, in an order denying the defendant hospitals’ motion to dismiss, the Southern District of New York became the first court to interpret and define the extent of a...more

When an Overpayment Becomes a False Claims Act Issue: Explaining the First Judicial Interpretation of the 60-Day Rule

Bradley Arant Boult Cummings LLP on 8/14/2015

On August 3, 2015, Judge Edgardo Ramos of the United States District Court for the Southern District of New York issued the first judicial opinion addressing when a health care provider has “identified” a Medicare or Medicaid...more

Kane and the “60-Day Rule”: The Unforgiving World of Medicare and Medicaid Overpayments

BakerHostetler on 8/14/2015

The Southern District of New York has spoken on one of the first issues to confront those seeking compliance with the new “60-day rule” under the Affordable Care Act (ACA), and it does not bode well for defendant hospitals...more

FCA 60-Day Repayment Provision Runs from Discovery of Potential Overpayment

Holland & Knight LLP on 8/12/2015

The U.S. District Court for the Southern District of New York issued the first decision directly addressing when an overpayment is “identified” for purposes of starting the 60-day repayment clock under the federal False...more

Blog: First Court Decision Interpreting the Overpayment Rule Issued This Week

Cooley LLP on 8/10/2015

Earlier this week, a key decision denying defendants’ motion to dismiss was issued in the case, Kane v. Healthfirst Inc., et al. and United States v. Continuum Health Partners Inc., et al. (case no. 1:11-cv-02325, S.D.N.Y.)....more

In Closely Watched Case, Federal Court Upholds the Government’s Position on Provider Mandate to Report and Return Medicare and...

Cadwalader, Wickersham & Taft LLP on 8/7/2015

The Patient Protection and Affordable Care Act (“PPACA”), signed into law on March 23, 2010, included a provision (the “Report and Refund Mandate”), broadly requiring health care providers, suppliers, Part D plans and managed...more

Ignorance Is Not Bliss: The 60-Day Clock under the ACA’s “Return and Report Rule” Can Start Ticking Well Before the Exact Amount...

Cozen O'Connor on 8/6/2015

On August 3, 2015, a federal judge in the Southern District of New York ruled that the United States’ and state of New York’s complaints in intervention can move forward against a group of hospitals, under the federal False...more

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