On January 3, 2022, the U.S. Court of Appeals for the Fifth Circuit Court reversed the decision of the District Court for the Western District of Louisiana dismissing for lack of jurisdiction a Medicare provider’s suit...more
On July 7, 2021, the U.S. District Court for the District of Columbia ruled in favor of HHS and upheld HHS’s 2013 rule readopting its policy of including Part C days in the Medicare fraction of the disproportionate share...more
On May 5, 2021, OIG issued guidance on its COVID-19 Administrative Enforcement FAQs page stating that an ambulance provider or supplier waiving or discounting Medicare beneficiary cost-sharing obligations presents a low risk...more
5/14/2021
/ Ambulance Providers ,
Anti-Kickback Statute ,
Beneficiaries ,
Coronavirus/COVID-19 ,
Department of Health and Human Services (HHS) ,
Emergency Medical Services (EMS) ,
Enforcement Actions ,
Medicare ,
OIG ,
Public Health Emergency ,
Reimbursements ,
Social Security Act ,
Waivers
On March 15, 2021, the Medicare Payment Advisory Commission (MedPAC) released its Medicare Payment Policy report to Congress updating payment recommendations for providers paid under Medicare’s traditional fee-for-service...more
On October 5, 2020, the U.S. Supreme Court declined to review a case questioning the materiality standard for Medicare fraud cases under the False Claims Act (FCA). The case involved allegations that Lawrence Memorial...more
On June 22, 2020, CMS issued a press release calling for a renewed national commitment to value-based payment models for healthcare providers rather than fee-for-service models. The proclamation came as CMS also released...more
On April 7, 2020, CMS announced it has approved nearly $34 billion in requests from over 17,000 healthcare providers and medical equipment suppliers through the expansion of the Accelerated and Advance Payment Program (the...more
On October 4, 2019, the DOJ announced a $6.65 million settlement with a Southern California ophthalmology group, its former CEO, and several physicians, to resolve False Claims Act (FCA) allegations related to fraudulent...more