Reimbursements

News & Analysis as of

Medicare’s 60-Day Proposed Refund Rule Imposes Significant Liability on Providers

As part of the Affordable Care Act, Congress outlined the process for providers to return Medicare and Medicaid overpayments. In 2012, CMS proposed the 60-day Refund Rule, as it is commonly known, requiring Medicare providers...more

High Court Employee Benefits Cases: A Review and Look Ahead

Having settled into the new year, we reflect on decisions from the U.S. Supreme Court in 2013 that are likely to have a significant impact in the world of pension and welfare employee benefits and, in some cases, already have...more

Missouri Supreme Court Holds Federal Act Does Not Preempt Missouri Law Barring Subrogation Of Personal Injury Claims

In essence overruling a previous opinion from the courts of appeal, the Missouri Supreme Court has held that the Federal Employee Health Benefits Act (“FEHBA”) does not preempt Missouri law prohibiting the subrogation of...more

Clawback Policies–What to Do?

Clawbacks have been around for more than a decade. - Beginning in 2002, Sarbanes-Oxley required CEOs and CFOs to reimburse incentive or equity compensation received or profits from the sale of company securities during...more

Even Though IRS Executives Do Not Know It, Employee Travel Reimbursements Can be Taxable

On Tuesday, February 18, 2014, the Treasury Inspector General for Tax Administration (TIGTA) issued a report reviewing the long-term travel of certain IRS executives and found that nine of the thirty one executives whose...more

Reinsurance Redux - Winter 2014

In This Issue: - New York District Court Grants Summary Judgment for Reinsurer Where Insured’s Loss Did Not Reach Attachment Point Necessary to Trigger Coverage: The United States District Court for the Southern...more

ICD-10 Compliance Deadline is October 1, 2014—Philadelphia Office of CMS to Offer Webinars to Ease Transition

ICD-9 diagnosis and inpatient procedure codes will make way for ICD-10 codes starting October 1, 2014. Health care entities and providers need to be ready to make the switch if they want to receive reimbursement for claims....more

Stand-Alone Health Reimbursement Arrangements May Not Be Dead After All

Many employers offer employees Health Reimbursement Arrangements (“HRAs”) to assist employees meet their health care related expenses. Often such employer funded arrangements are not “integrated” with an insured health plan,...more

Eighth Circuit Affirms False Claims Act Dismissal on Rule 9(b) Grounds

The U.S. Court of Appeals for the Eighth Circuit recently affirmed the dismissal of a False Claims Act (“FCA”) complaint in United States ex rel. Dunn v. North Memorial Health Care (8th Cir. No. 13-1099, Jan. 9, 2014) for...more

Great Investment For Doctors: Joint Venture Pharmacies

With reimbursement levels declining, health care organizations, including pharmacies and physicians, continue to look for ways to diversify their businesses. A very attractive vehicle for increasing revenues has been...more

Local Agencies May Submit Claims for State Reimbursement of Public Records Act Costs

Claims Must Be Filed No Later Than February 28, 2014 - The Office of the State Controller (SCO) has released instructions for local agencies to submit claims for state reimbursement of costs incurred between fiscal...more

New Decision Examines the Scope of Constructive Discharge

On December 31, 2013, in Vasquez v. Franklin Management Real Estate Fund, Inc., the California Court of Appeal held that a maintenance technician, who alleged that he was constructively discharged in violation of public...more

Hello, 2014! And Hello 3% Decrease in Medicaid Reimbursements (But Call the Decrease “Shared Savings”)

Tomorrow is the first Medicaid checkwrite for 2014. With the first Medicaid checkwrite tomorrow, due to Session Law 2013-360, many health care providers will receive 3% less in Medicaid reimbursements. You will receive a 3%...more

CVS Caremark Pays $4.25 Million to Settle False Claims Allegations

Earlier this month, Caremark Incorporated – a drug benefit management company operated by drug retail giant CVS Caremark Corporation –agreed to pay $4.25 million to settle allegations that it knowingly failed to reimburse...more

Medicaid DSH: Little-Noticed CMS Rule Interpretation Creates Serious Financial Shortfalls for Impacted Hospitals

In what may have been a largely unnoticed rule interpretation affecting hospitals that treat a high percentage of children in the Medicaid program, CMS, in January 2010, issued a response to a Frequently Asked Question (FAQ)...more

Florida Federal Court Grants Reinsurer’s Motion to Dismiss Because of Lack of Coverage

Public Risk Management of Fl. v. One Beacon Ins. Co., No. 6:13-cv-1067-Orl-31 TBS, 2013 U.S. Dist. LEXIS 150091, 2013 WL 5705575 (M.D. Fl. Oct. 18, 2013). A Florida federal court granted a reinsurer’s motion to dismiss...more

The “Relocation Costs” Reimbursement Arrangement: A Section 409A Trap for the Unwary.

When an employer requires an employee to move his or her primary residence to work, or continue working, for the employer, oftentimes the employer, as an inducement for the employee to accept the offer employment or continue...more

The Latest On Duty To Defend In Calif.

In the last two months, courts in California have issued several decisions concerning the scope of an insurer’s duty to defend its insured in underlying litigation. These decisions address important matters involving the...more

Something Borrowed, Something New, But IIGF Still Can’t Collect From Borrowing Employer’s Workers’ Comp Carrier

In Illinois Ins. Guaranty Fund v. Liberty Mutual Ins. Co., 2013 IL App (1st) 123345 (Nov. 12, 2013) the Illinois First District appellate court held that a borrowing employer’s workers’ compensation carrier is not required to...more

FHFA Announces Ban for Reimbursement of Expenses For Captive Reinsurance Arrangements

On November 5, 2013, the Federal Housing Finance Agency (FHFA) announced that Fannie Mae and Freddie Mac (the GSEs) will no longer reimburse their participating servicers for expenses arising out of captive reinsurance...more

Putting the Pieces Together: How the ACA Impacts Health Reimbursement and Flexible Spending Arrangements

Employers responding to the market reforms contained in the Affordable Care Act (“ACA,” also referred to as ObamaCare) are trying to grasp how it treats some current arrangements, such as health reimbursement arrangements...more

Weekly Law Resume - November 2013: Insurance Coverage-SIR Requirements

American Safety Indemnity Company v. Admiral Insurance Company - California Court of Appeal, Fourth Appellate District (September 27, 2013) - Many insurance policies contain a Self-Insured Retention (“SIR”) that...more

SuperVision Today: 4th Quarter 2013

In This Issue: - Federal Contractors Should be Planning Ahead for the New Section 503 and VEVRAA Rules - Putting the Pieces Together: How the ACA Impacts Health Reimbursement and Flexible Spending...more

Bill n°61: Solution to Amounts Paid Unjustly in the Construction Industry

After the revelations of corruption and collusion in the awarding of public contracts in the construction industry, most notably heard at the Charbonneau inquiry, the Government of Quebec announced its intention to table a...more

California Court Holds Insurer Entitled to Reimbursement of Defense Costs

In its recent decision in Great Am. Ins. Co. v. Chang, 2013 U.S. Dist. LEXIS 159197 (N.D. Cal. Nov. 6, 2013), the United States District Court for the Northern District of California had occasion to consider an insurer’s...more

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