CMS seeks to impose more rigorous program integrity requirements for contractors and states.
This article is part of a series that takes an in-depth look at several proposals that would affect managed care organizations,...more
Since the Center for Medicare & Medicaid Services proposed a rule three years ago suggesting that providers could be liable for returning Medicare overpayments going back ten years, providers have been anxiously awaiting a...more
On Nov. 20, 2014, the U.S. Department of Justice (“DOJ”) announced settlements and judgments for False Claims Act (“FCA”) cases totaling $5.7 billion (compared to $3.8 billion in fiscal year 2013), $2.3 billion of which was...more
In This Issue:
- Government demonstrates willingness to enforce Affordable Care Act provision that could cost providers millions of dollars
- Words can come back to haunt you: Boilerplate pleading could lead...more
Under a little-known provision of the Patient Protection and Affordable Care Act (“ACA”), healthcare providers could face millions of dollars in liability for failing to reimburse the government for overpayments in a timely...more
On September 22, 2014, Mount Sinai Health System (Mount Sinai) filed a motion to dismiss a groundbreaking lawsuit filed against it in a New York federal district court. The suit is the first publicly unsealed whistleblower...more
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
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
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
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
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
District Court Finds That Medical Group’s Failure to Further Investigate Audit Results May Violate Requirement to Return Overpayments -
Internal audits of third-party payment claims – frequently...more
During the past several years, prosecutors have increasingly used Deferred Prosecution Agreements (DPAs) against corporations in enforcing white collar criminal statutes. DPAs have enabled companies to avoid the costs and...more
Sometimes the deck is stacked against you. No matter what you do and how hard you try, you will lose.
In the healthcare area, hospitals, doctors and other service providers have to feel the frustration when it comes...more
The Supreme Court’s decision upholding most of the Affordable Care Act increased compliance responsibilities for healthcare companies. The ACA amended the False Claims Act (FCA), which was amended in 2009 in the Fraud...more
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