Matthew Westbrook

Matthew Westbrook

Proskauer Rose LLP

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CMS to Immediately Begin Auditing Medicare Advantage Plans in Significant Expansion of Enforcement Efforts

On May 21, 2025, the Centers for Medicare and Medicaid Services (“CMS”) announced a significant expansion of its auditing efforts with respect to Medicare Advantage (“MA”) plans....more

5/27/2025  /  Audits , Centers for Medicare & Medicaid Services (CMS) , Enforcement Actions , Healthcare , Healthcare Fraud , Medicare Advantage , Regulatory Requirements , Reimbursements , Risk Management , Trump Administration

CMS Publishes Final Rule, Effective January 1, 2025, Addressing the Requirements for Reporting and Returning Overpayments

The standard for an “identified overpayment” under Medicare Parts A–D now aligns with section 1128J(d)(4)(A) of the Social Security Act, which incorporates by reference the Federal False Claim Act’s (the “FCA”) “knowledge”...more

1/28/2025  /  Centers for Medicare & Medicaid Services (CMS) , Compliance , Department of Justice (DOJ) , Enforcement , False Claims Act (FCA) , Final Rules , Medicare , Medicare Advantage , Overpayment , Reporting Requirements , Risk Management

OIG Releases Special Fraud Alert About Suspect Payments in Marketing Arrangements Related to Medicare Advantage and Providers

On December 11, 2024, the Office of Inspector General for the U.S. Department of Health and Human Services (“OIG”) issued a special fraud alert warning about certain marketing schemes that involve questionable payments and...more

12/18/2024  /  Anti-Kickback Statute , Compliance , Department of Health and Human Services (HHS) , Department of Justice (DOJ) , Enforcement Actions , False Claims Act (FCA) , Fraud Alerts , Health Care Providers , Marketing , Medicare Advantage , OIG , Telemedicine , Third-Party

CMS Proposes Additional Modifications to the Overpayment Rule Relating to the Deadline for Reporting and Returning Overpayments

In the context of Medicare Advantage (“MA”) reform initiatives, we previously addressed the Centers for Medicare & Medicaid Services’ (“CMS”) December 27, 2022 proposal to amend its regulations set forth at 42 C.F.R. §...more

8/6/2024  /  Centers for Medicare & Medicaid Services (CMS) , False Claims Act (FCA) , Final Rules , Healthcare Fraud , Investigations , Medicare Advantage , Medicare Part D , Overpayment , Physician Fee Schedule , Proposed Rules , Regulatory Reform , Reporting Requirements , Voluntary Disclosure

Medicare Advantage 2024 Rate Announcement – Further Impacts to Risk Adjustment

On Friday, March 31, 2023, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2024 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies (Rate Announcement). This Rate...more

4/4/2023  /  Centers for Medicare & Medicaid Services (CMS) , False Claims Act (FCA) , Fee-for-Service , Medicare , Medicare Advantage , Medicare Advantage Organizations (MAOs) , Medicare Part C , Medicare Part D , MedPAC , Social Security Act

The Supreme Court Denies Petition Challenging CMS’s Overpayment Rule

This past week, the Supreme Court of the United States (Supreme Court) denied UnitedHealthcare Insurance Company’s (UnitedHealthcare) petition for a writ of certiorari (Petition) challenging, in part, the Centers for Medicare...more

6/27/2022  /  Centers for Medicare & Medicaid Services (CMS) , Denial of Certiorari , False Claims Act (FCA) , Fee-for-Service , Health Insurance , Healthcare , Medicare Advantage , Overpayment Recovery Time Limits , SCOTUS
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