News & Analysis as of

Medicare Administrative Remedies

Buchalter

Non-contracted Providers Must Exhaust Administrative Remedies for Medicare Advantage Claims

Buchalter on

Health plans routinely assert that contracted providers must appeal underpayments or claim denials according to the health plans’ internal dispute process. The payer/provider agreement itself, or provider manuals that health...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

Perkins Coie

Delaware Bankruptcy Court Decision Strengthens Protections for Healthcare Providers in Bankruptcies

Perkins Coie on

In an August 2019 case argued by Perkins Coie attorneys, the U.S. Bankruptcy Court for the District of Delaware ruled that the automatic stay under section 362(a) of the Bankruptcy Code bars the Centers for Medicare &...more

Mintz - Health Care Viewpoints

CMS Takes Another Swing at 340B Reimbursement Cuts. Will It Be Strike Three?

The proposed 2020 Outpatient Prospective Payment (OPPS) rule was published on August 9, 2019. Buried in the 819 pages of proposed changes and justifications, CMS took another swing at cutting Medicare Part B reimbursement...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

K&L Gates LLP

K&L Gates Triage: Medicare Overpayment Recoupment Halted by Court

K&L Gates LLP on

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

K&L Gates LLP

K&L Gates Triage: Recent Developments in Provider v. Payer Litigation -- Medicare Advantage Disputes

K&L Gates LLP on

In this episode, Gary Qualls discusses a recent development in payer litigation, regarding a provider’s recovery of Medicare Advantage payments pursuant to a Medicare Advantage contract. Specifically, a recent federal case...more

King & Spalding

Court Finds Provider Failed to Exhaust Administrative Remedies in Suit Against Government Contractor for Withheld Reimbursement

King & Spalding on

On August 28, 2017, the United States District Court for the Eastern District of Michigan held that a provider must fully exhaust administrative remedies before it can seek a remedy in Federal court against a Medicare...more

King & Spalding

California Court Rules Medicare Does Not Preempt Hospital Claims Against Payer

King & Spalding on

On April 27, 2016, a California state court judge in a Complex Litigation department for the County of Los Angeles, ruled in favor of 13 of our hospital clients on an important matter involving substantive and financial...more

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