Overpayment

News & Analysis as of

The Dark Side of Health Care Reform: The First “60-Day Rule” False Claims Act Case

The U.S. Department of Justice and New York State Attorney General’s Office recently intervened in a federal False Claims Act case in federal District Court based on allegations that a provider failed to report and refund an...more

The Government Intervenes In False Claims Act Case Alleging Failure To Return Overpayments Within 60 Days

On June 27, 2014, the United States intervened in a qui tam action under the False Claims Act alleging that certain New York hospitals failed to refund Medicaid overpayments within 60 days of identifying them, as required by...more

The Mistaken Fiduciary: Can You Correct Overpayments to U.S. Retirees?

Even the best run pension plans occasionally pay retirees the wrong amount due to errors in employee classification, or calculating participant service or compensation. Correcting underpayments is easy enough – though it is...more

No Refund Of Extension Overpayment Followed By A Code §6166 Election

If an estate files to extend the due date of its Form 706 estate tax return, it can elect to defer the portion of the estimated estate tax that will be deferred pursuant to its Code §6166 election. It does not make the...more

OIG: Medicare Inappropriately Paid for 2010 E/M Services Claims - Physicians should expect higher scrutiny on Medicare claims...

Inspector General Daniel R. Levinson with the Office of the Inspector General (“OIG”) recently issued a startling report explaining that Medicare inappropriately paid $6.7 billion for claims for E/M Services in 2010. These...more

OIG's Proposed Rule to Expand Civil Monetary Penalties

The Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) on May 12, 2014 published a proposed rule (Proposed Rule) that would implement the OIG’s expanded authority under the Affordable Care...more

CMS Announces Final Regulatory Changes to Medicare Advantage and Part D

- CMS issues final Medicare Advantage and Part D regulatory changes after a controversial proposed rule was announced earlier this year. - New requirements for the reporting and return of Medicare Advantage and Part D...more

OIG Says Medicare Overpaid Hospitals by $19 Million for Claims Subject to the Post-Acute Care Transfer Policy

On May 28, 2014, OIG released a report asserting that over $19 million in inappropriate payments were made to hospitals for inpatient claims subject to the post-acute care transfer policy. These overpayments were the result...more

Quantifying and addressing improper payments for Medicare evaluation and management services

A review of Medicare Part B claims for evaluation and management (E/M) services conducted by the Office of the Inspector General (OIG) has found that the program paid $6.7 billion in improper payments in 2010. This figure...more

CMS Changes to Medicare Advantage and Prescription Drug Benefit Programs for Contract Year 2015

On May 19, 2014, the Centers for Medicare & Medicaid Services (“CMS”) issued a final rule, published in the Federal Register on May 23, 2014, that sets forth changes to requirements for Medicare Advantage (“MA”) and...more

CMS's Focus on DMEPOS Fraud and Abuse Risks Continues

The focus by the Centers for Medicare & Medicaid Services (CMS) on Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) as an area rife with unnecessary utilization and a high improper payment rates...more

OIG Proposes Rule to Expand Civil Monetary Penalties and Solicit Comments on Penalty for Failure to Report and Return Overpayments...

Department of Health and Human Services, Office of Inspector General’s (OIG) proposed rule expands the use of civil monetary penalties and solicits comments on the penalty for failure to report and return overpayments. ...more

Gotham Insurance V. Warren E&P Answers Age-Old Question

In Gotham Insurance Co. v. Warren E&P Inc., the Texas Supreme Court recently addressed an age-old and often-asked question: Can an insurer recoup money paid to its insured when it later learns it overpaid? The answer:...more

Pricing Issues Affecting Laboratories

Craig Holden co-presented "New Compliance Red Flags Workshop," a workshop hosted by G2 Intelligence. Over the past five years, the Departments of Justice and Health and Human Services have recovered $19.2 billion from...more

Health Headlines: Also in the News - May 2014

OIG Reports Jurisdiction H Contractors Made $3.3 Million in Overpayments for Outpatient Drugs – According to a recent OIG report, the Medicare Contractors for Jurisdiction H overpaid providers approximately $3.3...more

Recent OIG Report Underscores Need for Home Health Agencies and Physicians to Comply With Medicare’s Face-to-Face Documentation...

Medicare overpaid the home health industry $2 billion between January 2011 and December 2012, according to a recent report by the U.S. Department of Health and Human Services, Office of Inspector General (OIG). The OIG’s...more

Extrapolating Overpayment Claims

Overpayment audits of physicians are common place and, indeed, should now be expected. When conducting such audits, Medicare auditors often include not only random sampling as an audit technique but have also extrapolated...more

Court Rejects Plaintiff’s Attempt to Prevent Plan from Recouping $250,000 Overpayment

A federal district court in the Northern District of California dismissed an equitable estoppel claim brought by a pension-plan participant seeking to prevent the plan from recouping an overpayment. See Groves v. Kaiser...more

Sixth Circuit Refuses To Permit Judicial Review Prior To Conclusion Of Reinsurance Arbitration Proceeding

The Sixth Circuit recently reversed a district court’s decision to stay arbitration proceedings in a dispute concerning allegations of overbilling on a reinsurance program. The arbitration clause from the treaty established a...more

Medicare’s 60-Day Proposed Refund Rule Imposes Significant Liability on Providers

As part of the Affordable Care Act, Congress outlined the process for providers to return Medicare and Medicaid overpayments. In 2012, CMS proposed the 60-day Refund Rule, as it is commonly known, requiring Medicare providers...more

Interest On Tax Overpayments–Not Always Available

Code §6611 provides that the IRS will pay interest on tax overpayments back to the due date if the overpayment is not refunded within 45 days of the refund claim (or within 45 days of the return due date for a timely filed...more

Third Circuit Holds Judicial Review of Extrapolated Overpayment Determinations is Precluded

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

Streamlined RAC Appeal Processes Lead To Winning Legal And Economic Outcomes

Armed with the Recovery Audit Contract (RAC) Program, the Federal government has been very successful in recouping Medicare overpayments from health care providers in recent years. During a RAC audit, program contractors...more

Proposed Overpayment Reporting Requirements for MA and Part D Programs May Increase False Claims Act Liability

The Centers for Medicare & Medicaid Services continues to take an expansive view of the overpayment refund requirement, which in turn can give rise to False Claims Act liability for Medicare Advantage Organizations and Part D...more

False Claim Act: 2013 Year in Review

Last year continued the trend of robust False Claims Act (FCA) enforcement by the U.S. Department of Justice (DOJ) and proliferating qui tam lawsuits brought by whistleblowers on behalf of the United States. In 2012, DOJ...more

96 Results
|
View per page
Page: of 4