Overpayment

News & Analysis as of

CMS Proposes Expansion of RAC Program to Medicare Part C – All Medicare Advantage Contracts to Become Target of RADV Audits

On December 22, 2015, the Centers for Medicare & Medicaid Services (CMS) released a request for information (RFI) and a proposed statement of work (SOW) seeking industry feedback on the expansion of the recovery audit...more

Another Day, Another Whistleblower Retaliation Suit

A False Claims Act (“FCA”) retaliation claim, 31 U.S.C. 3730(h), filed January 26, 2016 in federal district court in Oregon, provides a perfect example of the type of challenging cases confronting health care employers today....more

2015 – The Health Law Year in Review

With 2015 in the books, we are pleased to reflect on some of the major developments over the past year in the field of health law. The year was marked by changes in Medicare payment models—from government pronouncements...more

Understanding When An Overpayment Can Result in False Claims Liability and Why Current Court Precedent and Regulatory Guidance Is...

An issue every health care entity that submits claims to the government must frequently confront is when and how to disclose an overpayment to the government. This issue arises when, for example, an employee expresses concern...more

Supreme Court ERISA Cases: Plan Reimbursement for Overpayment (Part I)

In its current term, the Supreme Court is set to hear oral arguments on three cases that interpret the Employee Retirement Income Security Act of 1974 (ERISA). The three ERISA cases will inevitably have an effect on plan...more

Watch the Employer Deductions — Except for One Special Case

Connecticut has pretty strict rules that employers must follow if they want to take deductions off of an employee’s salary. Typically, an employer must seek CTDOL approval for all sorts of deductions, which I covered back in...more

Don’t Mail That Overpayment Disclosure Just Yet: Implications of CMS’ Final Rule Expanding the Writing, Signature and Holdover...

The Centers for Medicare and Medicaid Services (CMS) on Nov. 16, 20151 published the calendar year 2016 physician fee schedule final rule, fundamentally reducing the burden on entities seeking to demonstrate compliance with...more

Pennsylvania Commonwealth Court Declares Corporate Net Income Tax Net Operating Loss Scheme Unconstitutional

Taxpayers that are in a positive net operating loss carryover position, but that paid tax in any open year due to the statutory scheme, should file protective refund claims seeking a refund for any overpaid tax....more

Labor Law Section Expanding Right of Employers to Make Deductions From Employees’ Wages Has Been Extended for Another Three Years

New York employers will recall that on November 6, 2012, the State Legislature enacted sweeping changes to Section 193 of the State Labor Law, expanding the categories of permissible deductions that employers may make from...more

Developments in Long-Term Care Q2 2015

The following summary highlights key federal court developments and administrative decisions involving skilled nursing facility survey and related issues during the second quarter of 2015....more

New York Extends Sunset Provision on 2012 Wage Deduction Law Amendments to 2018

UPDATE: On October 26, 2015, Governor Cuomo signed a bill (A07594) extending the expiration period of the 2012 amendments to New York Labor Law 193 from three years after their effective date (November 6, 2015) to six...more

UPDATE - New York Wage Deduction Law Will NOT Expire November 6

On November 6, 2015, amendments to the New York Labor Law (NYLL) that expanded permitted deductions from wages for overpayments and advances against wages, among other items, will expire. In 2012, New York expanded the...more

Skeletons in the Closet? Beware of Potential Enforcement Actions

With Halloween looming, a discussion of skeletons that may be lurking in a health care provider’s closet is timely. Many of our previous posts, as well as the monthly Qui Tam Updates published by our Health Care Enforcement...more

OMB Receives Final Medicare Parts A and B 60-Day Overpayment Rule from CMS

On October 21, 2015, the Office of Management and Budget (OMB) received the Medicare Parts A and B overpayment final rule from CMS which is the last phase before the rule is issued in the Federal Register. While the text of...more

OIG Hospital Compliance Audits: Is Your Number Up? Are You Ready?

In its Work Plan for Fiscal Year 2012, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) announced it would begin reviews of Medicare payments to hospitals to determine compliance...more

CMS Sends Long-Awaited Medicare 60-Day Overpayment Rule to OMB for Final Clearance

CMS is moving ahead on its much-anticipated final rule implementing Affordable Care Act (ACA) requirements on reporting and returning of Medicare overpayments. Under the ACA, enrolled providers and suppliers (and certain...more

Mintz Levin Health Care Qui Tam Update: Recently Unsealed Whistleblower Cases: October 2015

Trends & Analysis: ..We have identified 15 health care–related qui tam cases that were unsealed since our last Qui Tam Update. Of those, 12 were filed from 2012 to the present. All but two cases had been pending more...more

That is SO last week - October 2015

Last week saw a lot of media coverage about “Yelp for People.” The app, called Peeple, allows users to rate friends, co-workers, and romantic partners based on a five-star rating system. Recruiters could review the ratings...more

Fixing Your Mistakes: Henia Investments v Beck Interiors

Since 2011, Employer and Contractors have been living with the payment regime prescribed by the updated Housing Grants, Construction and Regeneration Act 1996. This regime amounts to strict liability for the payer – if...more

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

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

Attorneys Fees Under California’s Prompt Payment Statutes. Contractor’s “Win” Fails the Sniff Test

This past month, the California Court of Appeals for the Third District, in  James L. Harris Painting & Decorating, Inc. v. West Bay Builders, Inc., Case No. C072169 (August 27, 2015), handed down a decision in a construction...more

3rd Quarter 2015 Federal Tax Overpayment and Underpayment Interest Rates

Please see chart below for more information....more

The Mandatory Disclosure Rule – Demystifying Your Disclosure Requirements

It’s that gut-check scenario: You realize that your company has made a mistake on an invoice submitted on a government contract, or that your company has mistakenly represented its size or socioeconomic status. Regardless of...more

The Definition of Identify: The 60-Day Rule

The Patient Protection and Affordable Care Act (“PPACA”) established that any person who receives an overpayment from the Medicare or Medicaid programs and who does not report and return the overpayment within 60 days after...more

The 60 Day Rule — Identification and Knowing Avoidance

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

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