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Fifth Circuit Holds District Court Has Jurisdiction to Decide Repayment Amount Owed by HHS to Medicare Provider as an...

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

D.C. District Court Upholds HHS’s 2013 Policy of Including Part C Days in the Medicare Fraction of the DSH Calculation

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

OIG Updates COVID-19 Administrative Enforcement FAQs With Question Regarding Ambulance Providers’ Waiver or Discount of Certain...

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

MedPAC Issues Medicare Payment Policy Report to Congress

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

U.S. Supreme Court Declines to Review False Claims Act Materiality Standard

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

CMS Calls for Renewed Commitment to Value-Based Care in Light of New COVID-19 Data

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

CMS Approves $34 Billion in Medicare Payment Advances

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

DOJ Settles False Claims Act Case Against Southern California Ophthalmology Group

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

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