News & Analysis as of

Administrative Law Judge (ALJ) Office of the Inspector General Centers for Medicare & Medicaid Services (CMS)

Hendershot Cowart P.C.

CMS, Qlarant Scrutinizing Medicare Claims for Skin Substitute Treatments

Hendershot Cowart P.C. on

Our firm is seeing an uptick in Medicare demand letters for the recovery of overpayment for skin substitutes, such as WoundFixTM, Biobrane, Dermagraft®, AmnioBand®, or AlloPatch®, used in the treatment of wounds. CMS auditors...more

Arnall Golden Gregory LLP

Texas Court Holds That Medicare Payment Suspensions Cannot Be Challenged In Federal Court

When the Centers for Medicare and Medicaid Services (CMS), through a Medicare contractor, conducts a post-payment audit of a provider’s Medicare reimbursements and determines that the provider may have received an...more

Mintz - Health Care Viewpoints

OIG Publishes Study on Claim and Payment Denials by Medicare Advantage Organizations

The HHS Office of the Inspector General (“OIG”) has reported the results of a study assessing service and payment denials by Medicare Advantage Organizations (“MAOs”). The study revealed “widespread and persistent MAO...more

K&L Gates LLP

Health Care Institutions

K&L Gates LLP on

Originally published in Haig, Business and Commercial Litigation in Federal Courts, Fourth Edition §§ 87:1 et seq. © 2016 American Bar Association. This chapter discusses federal court litigation relating to health care...more

BakerHostetler

ALJ Appeals Frequently Favorable To Providers; OIG Calls For Reforms

BakerHostetler on

The OIG recently published a report reviewing the implementation of 2005 regulations regarding the administrative law judge (ALJ) level of appeals, the third level of the Medicare appeals system. The 2005 regulatory changes...more

King & Spalding

OIG Concludes Improvements Needed at ALJ Level of Review

King & Spalding on

The OIG issued a report on November 15, 2012 (OEI-02-10-00340) in which it concluded that the administrative law judge (ALJ) level of appeal requires improvements in a number of areas due to (i) apparent substantive...more

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