News & Analysis as of

Hi-Tech Pharmacal Co. to Pay $25 Million in Settlement with Texas AG for Medicaid Fraud

The Texas Attorney General announced on January 7, 2013 that New York pharmaceutical company Hi-Tech Pharmacal Co. will pay the state of Texas and the federal government a combined $25 million to settle the government’s...more

CMS Revises Benefit Policy Manual to Comply with Jimmo Settlement Agreement

CMS has issued revisions to the Medicare Benefit Policy Manual to comply with the settlement agreement approved in the nationwide class action lawsuit, Jimmo vs. Sebelius. In Jimmo, the plaintiff class alleged that Medicare...more

Threshold Dollar Amount For Reporting Settlements to Medicare Drops To $2,000; CMS Issues New User Guide

The threshold dollar amount for when private and public employers and insurers are required to report payments to Medicare enrollees pursuant to settlements and judgments has been lowered from $5,000 to $2,000, and will...more

Whistleblowing to the Tune of $6 Million

In early July 2013, Baxano Surgical Inc., formerly known as TranS1 Inc., agreed to pay $6 million to settle charges that it encouraged doctors to overcharge Medicare and other federal health programs and paid kickbacks to...more

Adjusters: Best Practices for Dealing with Liens

In dealing with a workers’ compensation claim, adjusters will want to be sure to be aware of any other entities that may have a lien on money that might be awarded to the injured worker. In North Carolina workers’...more

Prospective and Retrospective Implications of the Jimmo Settlement Agreement for Skilled Care Providers

On January 24, 2013, the U.S District Court for the District of Vermont approved a Settlement Agreement in the so-called Medicare Improvement Standard case, Jimmo v. Sebelius. In addition to its impact on Medicare...more

Major New Jersey Health System Pays $12.6 Million To Settle False Claims Act Suit Alleging Physician Kickback Scheme

Federal prosecutors recently announced a $12.6 million False Claims Act (FCA) settlement with a major New Jersey health system to resolve allegations that the system paid outside physicians in order to increase referrals....more

Proposed Medicare Settlement Clarifies CMS’s Position on “Skilled Maintenance Services”

On October 16, 2012, in the case of Jimmo v. Sebelius, Case No. 5:11-CV-17 (D. Vt. October 16, 2012), a class of Medicare beneficiaries and the United States Department of Health and Human Services agreed to a proposed...more

Ethics Opinions Underscore Problems That Medicare Liens Create when Negotiating Settlements

In serious personal injury cases, a common issue arises in settlement talks that affect the course of negotiations – Liens; Specifically, health insurer liens and liens asserted by Medicare. The problem is simple: a plaintiff...more

Supreme Court Will Not Review Sixth Circuit Ruling That Government May Seek Full Reimbursement of Medicare Payments to Beneficiary...

On October 1, 2012, the United States Supreme Court said it would not review a decision by the U.S. Court of Appeals for the Sixth Circuit which ruled 2-1 that, upon settlement by a Medicare beneficiary with a third-party...more

Changes Coming for Medicare Set-Aside Arrangements

The law governing Medicare Set-Aside Arrangements (“MSAs”) in personal injury liability lawsuits may soon be changing. In personal injury liability cases, MSAs are funds from a judgment or settlement allocated to cover the...more

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