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Administrative Appeals Overpayment

King & Spalding

OIG Hospital Compliance Program Audit Claims $22 Million in Extrapolated Overpayments

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A recent report issued by OIG finding an Indiana community hospital owed over $22 million in extrapolated overpayments carries some important lessons for hospitals audited under OIG’s hospital compliance program. As described...more

Bass, Berry & Sims PLC

Judicial Opinions Support Delay of Recoupment from Audit Appeals Until After ALJ Hearings in Certain Circumstances

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Recent opinions by the Fifth Circuit, the Northern and Southern Districts of Texas, and the District of South Carolina offer hope to providers seeking relief from substantial monetary recoupments during the Medicare appeals...more

Foley & Lardner LLP

CMS Recoupment Efforts Stopped by Court While Overpayment Appeals Are Pending

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Providers and suppliers who have been assessed overpayments for Medicare services are entitled, by statute, to a stay of recoupment while the provider or supplier’s appeal is pending – but only at the first two levels of...more

Jones Day

Texas Federal District Court Prevents Withholding of Medicare Payments

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In a much-anticipated decision in Family Rehab., Inc. v. Azar, Federal Judge Kinkeade enjoined the Centers for Medicare & Medicaid Services ("CMS") from withholding Medicare payments to effectuate the recoupment of the...more

Jones Day

Fifth Circuit Provides Relief for Providers Facing Medicare Appeal Backlogs

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The U.S. Court of Appeals for the Fifth Circuit has provided some relief to health care providers seeking to stop Medicare from "recouping" alleged overpayments before the provider can obtain a hearing before an...more

Baker Donelson

Court Finds Jurisdiction to Bar Recoupment Associated with Pending Claims Appeal

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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

Robinson+Cole Health Law Diagnosis

Fifth Circuit Reinstates Provider’s Collateral Challenge to the Medicare Appeal Process

On March 27, 2018, the United States Court of Appeals for the Fifth Circuit held that a health care provider can seek an injunction in federal court against recoupment by Medicare of alleged overpayments despite not...more

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