In a decision with implications that could go back 35 years, the United States Court of Appeals for the District of Columbia Circuit rejected a CMS interpretation of its reopening rules as that interpretation affects current...more
On March 27, 2018, the United States Court of Appeals for the Fifth Circuit published an opinion that provides Family Rehabilitation, Inc. (Family Rehab) a second chance to postpone recoupment of about $7.6 million in...more
4/12/2018
/ Administrative Appeals ,
Administrative Backlogs ,
Administrative Law Judge (ALJ) ,
Appeals ,
Dismissals ,
Due Process ,
Exhaustion Doctrine ,
Health Care Providers ,
Judicial Review ,
Medicare ,
Overpayment ,
Preliminary Injunctions ,
Recoupment ,
Reversal ,
Social Security Act ,
Subject Matter Jurisdiction ,
TRO ,
Ultra Vires
On December 26, 2017, the United States Court of Appeals for the District of Columbia Circuit upheld the procedural validity of 2010 manual instructions setting out the criteria by which Medicare outlier payments might be...more
For much of the past decade, hospitals and CMS have battled over whether providers may claim, as Medicare reasonable costs, the full amount of provider tax assessments levied upon them by the states in which they operate. In...more
1/17/2018
/ Appeals ,
Arbitrary and Capricious ,
Centers for Medicare & Medicaid Services (CMS) ,
Health Care Providers ,
Hospitals ,
Medicaid ,
Medicare ,
Medicare Taxes ,
Physician Medicare Reimbursements ,
Provider Reimbursement Manual ,
Provider Reimbursement Review Board ,
Refunds ,
Reversal
Hospitals affected by HHS's 2014 decision to include Medicare Part C enrollees as part of the Medicare fraction of the disproportionate share calculation obtained relief late last month when that position was voided by the...more
8/28/2017
/ Administrative Procedure Act ,
Appeals ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Disproportionate Share Adjustments ,
DSH Adjustments ,
Hospitals ,
Medicare ,
Medicare Part C ,
Notice and Comment ,
Provider Payments ,
Retroactive Application ,
Reversal