Overpayment, Medicare | JD Supra Law News

Recent Changes Impact Appeal of Medicare Denials and Reimbursement Strategies

by Womble Carlyle Sandridge & Rice, PLLC on 4/17/2013

Recovery Audit Contractors (“RACs”) and other Centers for Medicare and Medicaid Services (CMS) contractors are charged with identifying overpayments made by Medicare to healthcare providers. However, with the increase in RAC...more

Hospitals: Audits And Compliance

by Michael Volkov on 4/2/2013

Hospitals are under intense scrutiny. The federal government knows that one sure way to reduce healthcare costs is to get hospitals to lower their costs. Hospitals feel the pinch given the need to generate revenue but know...more

OIG Recommends Increased CMS Enforcement of SNF Standards

by Holly Barker, Kathleen McDermott | Morgan Lewis on 3/22/2013

Amid alleged failures of skilled nursing facilities to meet care and discharge planning requirements, OIG identifies substantial payment errors....more

GAO Report Finds that CMS Overpaid Medicare Advantage Plans in 2010, 2011 and 2012

by King & Spalding on 3/14/2013

On March 4, 2013, the GAO released a report titled, Substantial Excess Payments Underscore Need for CMS to Improve Accuracy of Risk Score Adjustments, in which the GAO concluded that CMS overpaid Medicare Advantage plans (MA)...more

Deferred Prosecution Agreements: How an Effective Compliance Program Can Help You Plan for the Unpredictable

by John S. Linehan, Gina L. Simms | Ober|Kaler on 2/27/2013

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

Annual Report Shows Meteoric Rise in RAC Activity

by Ameena Ashfaq, B. Scott McBride | BakerHostetler on 2/27/2013

On February 5, 2013, CMS issued its mandatory Recovery Audit Contractor (RAC or Recovery Auditor) program annual report, detailing overpayments, underpayments, RAC performance and savings to the Medicare program. According to...more

CMS Publishes Annual Update On Recovery Audit Activity, Says Program Returned Nearly $490 Million to Medicare Trust Fund in 2011

by King & Spalding on 2/13/2013

On February 5, 2013, CMS sent Congress a report summarizing developments related to its Medicare recovery audit program for fiscal year (FY) 2011. According to the report (titled Recovery Auditing in the Medicare and...more

Payment Matters: No Judicial Review of Contractor’s Finding of a High Payment Error Rate, a Condition for Extrapolation

by Mark A. Stanley | Ober|Kaler on 2/11/2013

Before a Medicare contractor can use extrapolation to determine an overpayment amount, the Medicare statute requires that it must make a finding that there is a sustained or high level of payment error or that documented...more

OIG Recommends that CMS Recoup More Than $100 Million in Overpayments for Incarcerated and Unlawfully Present Beneficiaries

by King & Spalding on 1/31/2013

CMS made more than $100 million in improper payments to providers for healthcare services on behalf of incarcerated and unlawfully present individuals between 2009 and 2011, according to a pair of reports issued on January...more

OIG Concludes in Nationwide Review of Drug That Herceptin Has Often Been Overbilled

by King & Spalding on 1/30/2013

The HHS OIG has conducted a nationwide audit of the use and reimbursement of Herceptin (also known as trastuzumab), a Medicare-covered drug used to treat metastatic breast cancer, and has concluded in three audits released in...more

Supreme Court Opinion in Sebelius v. Auburn Regional Medical Center Rejects a Challenge by Hospitals to Medicare's SSI Fraction...

by Stuart M. Gerson, Robert Wanerman | Epstein Becker & Green, P.C. on 1/25/2013

A unanimous Supreme Court has issued its opinion in Sebelius v. Auburn Regional Medical Center, No. 11-1231 (Jan. 22, 2013), rejecting a challenge by hospitals to Medicare's Supplemental Security Income ("SSI") fraction...more

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Overpayment › Medicare

Recent Changes Impact Appeal of Medicare Denials and Reimbursement Strategies

Hospitals: Audits And Compliance

OIG Recommends Increased CMS Enforcement of SNF Standards

GAO Report Finds that CMS Overpaid Medicare Advantage Plans in 2010, 2011 and 2012

Deferred Prosecution Agreements: How an Effective Compliance Program Can Help You Plan for the Unpredictable

Annual Report Shows Meteoric Rise in RAC Activity

CMS Publishes Annual Update On Recovery Audit Activity, Says Program Returned Nearly $490 Million to Medicare Trust Fund in 2011

Payment Matters: No Judicial Review of Contractor’s Finding of a High Payment Error Rate, a Condition for Extrapolation

OIG Recommends that CMS Recoup More Than $100 Million in Overpayments for Incarcerated and Unlawfully Present Beneficiaries

OIG Concludes in Nationwide Review of Drug That Herceptin Has Often Been Overbilled

Supreme Court Opinion in Sebelius v. Auburn Regional Medical Center Rejects a Challenge by Hospitals to Medicare's SSI Fraction...

Health Reform + Related Health Policy News Update - January 16, 2013

Payment Matters: Extension of Time for Overpayment Recoveries in Fiscal Cliff Law Not as Broad as it Sounds

American Taxpayer Relief Act Amends Overpayment Recovery Time Limits

CMS Issues Medicare Quarterly Provider Compliance Newsletter

Healthcare Prosecutions for Failures to Return Overpayments

Payment Matters: Sovereign Immunity Extended to Medicare Contractors

Healthcare Companies Need to Update Compliance

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