In this episode, Gary Qualls discusses a recent development in payer litigation, regarding a provider’s recovery of Medicare Advantage payments pursuant to a Medicare Advantage contract. Specifically, a recent federal case...more
7/26/2018
/ Administrative Appeals ,
Administrative Remedies ,
Breach of Contract ,
Centers for Medicare & Medicaid Services (CMS) ,
Health Care Providers ,
Health Insurance ,
Hospitals ,
Insurer Liability ,
Jurisdiction ,
Medicare ,
Medicare Advantage ,
Medicare Advantage Organizations (MAOs) ,
Patients ,
Payor Contracts ,
Preemption ,
State Law Claims ,
Underpayment
In an effort to resolve its backlog of Medicare appeals, the Department of Health & Human Services’ Office of Medicare Hearings and Appeals (OMHA) established a Settlement Conference Facilitation (SCF) pilot program in June...more