News & Analysis as of

Overpayment Social Security Act

King & Spalding

CMS Proposes Changes to Medicaid DSH Third-Party Payer Rule

King & Spalding on

On February 24, 2023, CMS issued a proposed rule updating its Medicaid Disproportionate Share Hospital (DSH) program regulations as a result of legislative changes made by the Consolidated Appropriations Act (CAA) of 2021....more

Bricker Graydon LLP

Skilled nursing facility operator settles false claims case involving allegations that the company failed to report and return...

Bricker Graydon LLP on

On June 29, 2021, the Department of Justice (DOJ) announced a settlement with California skilled nursing facility operator Plum Healthcare Group LLC and facility Azalea Holdings LLC dba McKinley Park Care Center (Plum) to...more

McDermott Will & Emery

New Guidance on Medicare Payment Rule Enforcement

McDermott Will & Emery on

A few days before Thanksgiving, the news media published an internal memo by the Office of General Counsel (OGC) at the US Department of Health and Human Services (Department) to officials at the Centers for Medicare and...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

Baker Donelson

Court Finds Jurisdiction to Bar Recoupment Associated with Pending Claims Appeal

Baker Donelson on

On March 27, 2018, the United States Court of Appeals for the Fifth Circuit published an opinion that provides Family Rehabilitation, Inc. (Family Rehab) a second chance to postpone recoupment of about $7.6 million in...more

Morgan Lewis

The 60-Day Rule Is Final: Assessing Your Organization’s Safeguards

Morgan Lewis on

Follow these tips to ensure compliance in the wake of the new 60-Day Rule. On February 12, the CMS finalized the 60-Day Overpayment Report and Refund rule (60-Day Rule) for Medicare Parts A and B. This long-awaited rule...more

Mintz

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

Mintz on

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

Mintz - Health Care Viewpoints

CMS Delays 60-Day Rule, But Overpayment Case Law Emerging

The Centers for Medicare & Medicaid Services (CMS) recently announced a one-year delay in finalizing the long-awaited and closely watched rule addressing the 60-day deadline to return Medicare and Medicaid overpayments (the...more

Baker Donelson

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

Baker Donelson on

The recently passed fiscal cliff legislation, i.e., the American Taxpayer Relief Act of 2012 (Act) [PDF], includes a number of provisions addressing Medicare and Medicaid. One of these provisions extends the recovery period...more

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