News & Analysis as of

Overpayment Recovery Time Limits

Sheppard Mullin Richter & Hampton LLP

CMS Issues Long-Awaiting Medicare Advantage RADV Final Rule

On January 30, 2023, the Centers for Medicare & Medicaid Services (“CMS”) released the long-delayed final rule on risk adjustment data validation (“RADV”) audits of Medicare Advantage (“MA”) organizations (the “Final...more

Robinson+Cole Health Law Diagnosis

No More Reasonable Diligence? CMS Proposes to Change Standard for Identifying Medicare Overpayments to Align with False Claims Act

On December 27, 2022, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule (Proposed Rule) which proposes certain policy and technical changes to Medicare regulations, including a notable change to the...more

Proskauer - Health Care Law Brief

The Supreme Court Denies Petition Challenging CMS’s Overpayment Rule

This past week, the Supreme Court of the United States (Supreme Court) denied UnitedHealthcare Insurance Company’s (UnitedHealthcare) petition for a writ of certiorari (Petition) challenging, in part, the Centers for Medicare...more

Epstein Becker & Green

CMS Wins on Partial Appeal—D.C. Circuit Court Rules Against United’s Initially Successful Challenge to the Medicare Part C...

Epstein Becker & Green on

On August 13, 2021, the U.S. Court of Appeals for the District of Columbia Circuit (“D.C. Circuit”), in a much-anticipated decision, unanimously reversed rulings by the U.S. District Court for the District of Columbia...more

Health Care Compliance Association (HCCA)

In Provider Compliance Audit, OIG Said HHA Was Overpaid $5.9M

Report on Medicare Compliance 29, no. 30 (August 24, 2020) - Mission Home Health of San Diego Inc. was overpaid $61,718 in 2015 and 2016, which was extrapolated to $5.9 million, according to the latest Medicare home health...more

Health Care Compliance Association (HCCA)

Report on Medicare Compliance Volume 29, Number 13. News Briefs: April 2020

Report on Medicare Compliance 29, no. 13 (April 6, 2020) - During the coronavirus pandemic, the HHS Office of Inspector General (OIG) is “trying to minimize the burdens on providers,” said Christi Grimm, principal deputy...more

Ruder Ware

Apply the 60-Day Rule to Medicaid Overpayments

Ruder Ware on

The Affordable Care Act requires any person who has received an overpayment from certain defined government health programs to report and return the overpayment within 60 days after the overpayment is identified. If an...more

Baker Donelson

New Medicaid DSH Audit Guidance: Its Impact on Pending and Recent State DSH Audits

Baker Donelson on

On December 31, 2018, the Center for Medicaid and CHIP Services issued a notice indicating that CMS was altering its prior audit guidance for Medicaid Disproportionate Share Hospital (DSH) audits that had previously been...more

Bricker Graydon LLP

A 60-Day Overpayment Refund Rule update

Bricker Graydon LLP on

The 60-Day Overpayment Refund Rule (60-Day Rule) was enacted as Section 6402 of the Affordable Care Act (ACA) on March 23, 2010. ...more

Roetzel & Andress

Federal Court Overturns CMS Overpayment Rule

Roetzel & Andress on

A recent ruling by a federal district court could have a significant impact on how certain health insurers, specifically those providing coverage pursuant to Medicare Parts C (i.e., Medicare Advantage insurers) and D (i.e.,...more

Jones Day

D.C. District Court Vacates 60-Day Medicare Advantage Overpayment Rule

Jones Day on

The Situation: In 2016, several Medicare Advantage ("MA") organizations challenged a 2014 final rule promulgated by the Center for Medicare Services ("CMS") that broadly subjected MA organizations to potential liability under...more

Troutman Pepper

Court Rejects CMS's Attempt to Broaden False Claims Act Liability in Medicare Overpayment Rule

Troutman Pepper on

The U.S. District Court for the District of Columbia handed down a major victory to Medicare Advantage issuers on September 7, 2018, vacating a 2014 CMS regulation relating to Medicare Advantage overpayments. ...more

Akerman LLP - Health Law Rx

Courts May Now Stop Medicare from Recouping Payments

In recent years, many Medicare providers who have received significant overpayment determinations from Medicare contractors have gone out of business while waiting to be heard before an Administrative Law Judge (ALJ) for a...more

Baker Donelson

Physician Practice Penalized by DOJ for 60-Day Overpayment Rule Violation

Baker Donelson on

The Department of Justice (DOJ) imposed False Claims Act penalties against First Coast Cardiovascular Institute (FCCI) for failing to work credit balances and repay overpayments to federal health care programs. On October 13,...more

Williams Mullen

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

Williams Mullen on

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

Faegre Drinker Biddle & Reath LLP

Yes, Virginia, There Is a Reverse False Claim

The False Claims Act has a scienter requirement: it makes it illegal to knowingly present a false claim to the government. So if a company innocently presents a false claim, it can’t be guilty of violating the Act, right?...more

Spilman Thomas & Battle, PLLC

The Rise of Managed Care Audits and Reimbursement Demands in the Wake of the ACA

If the summer of 2017 demonstrated anything, it is that health care remains a complex and contentious industry. One of its many complications stems from the natural tension between health care providers and health care...more

Chambliss, Bahner & Stophel, P.C.

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

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

Dickinson Wright

Preventing Overpayments from becoming False Claims

Dickinson Wright on

Overpayments to healthcare providers receiving Medicare reimbursements are at risk of civil and criminal enforcement action if not attuned to a particular reimbursement rule and diligent in compliance with the rule’s...more

Ruder Ware

Repayment and Self Disclosure of Known Overpayments

Ruder Ware on

The 60-day repayment rule adopted as part of the Affordable Care Act is a very strong arrow in the quiver of federal enforcement agencies. Under the 60-day rule a known overpayment can become a False Claim if it is not repaid...more

Ruder Ware

Can Overpayments Create Criminal Liability?

Ruder Ware on

We hear a lot about potential liability under the False Claims Act (FCA) for the failure to repay overpayments within 60 days of discovery. Focus on the 60-day rule has taken focus away from the potential for criminal charges...more

Bass, Berry & Sims PLC

Healthcare Fraud and Abuse Review 2016

Bass, Berry & Sims PLC on

Bass, Berry & Sims is pleased to announce the release of its fifth annual Healthcare Fraud and Abuse Review 2016. The Review, compiled by the firm’s Healthcare Fraud Task Force, is an industry-leading guide to healthcare...more

Ruder Ware

The Case of the Very Very Impossibly Long, Terrible, Horrible, No Good, Very Bad Day

Ruder Ware on

How Fraud and Abuse Cases Arise in a Medical Practice - It is no secret many doctors work very long days. Some days are worse and some are better than others. As a compliance lawyer, my job is to attempt to prevent...more

Burr & Forman

2016 Health Care Year in Review

Burr & Forman on

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

Robinson & Cole LLP

Health Law Pulse - September 2016

Robinson & Cole LLP on

DOJ, NY AG REACH SETTLEMENT WITH HOSPITALS IN LANDMARK 60 - DAY RULE CASE - On August 24, 2016, the U.S. attorney for the Southern District of New York and the New York State attorney general announced a $2.95 million...more

83 Results
 / 
View per page
Page: of 4

"My best business intelligence, in one easy email…"

Your first step to building a free, personalized, morning email brief covering pertinent authors and topics on JD Supra:
*By using the service, you signify your acceptance of JD Supra's Privacy Policy.
- hide
- hide