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Centers for Medicare & Medicaid Services (CMS) › Breach of Contract

Wiley Rein LLP

Eighth Circuit Affirms Medicare Reimbursement Claim Is Not “Based on Professional Services”

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The United States Court of Appeals for the Eighth Circuit, applying Iowa law, has held that a professional liability insurer had no duty to defend and indemnify a medical clinic and its director for claims by the clinic...more

Skadden, Arps, Slate, Meagher & Flom LLP

HHS OIG Closes 2018 With New Fraud Risk Indicator for Corporate Integrity Agreements

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While the number of new corporate integrity agreements (CIAs) declined since last year, and was below the trailing five-year average, 2018 was an important year on the policy front for the Office of Inspector General (OIG),...more

K&L Gates LLP

K&L Gates Triage: Recent Developments in Provider v. Payer Litigation -- Medicare Advantage Disputes

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In this episode, Gary Qualls discusses a recent development in payer litigation, regarding a provider’s recovery of Medicare Advantage payments pursuant to a Medicare Advantage contract. Specifically, a recent federal case...more

K&L Gates LLP

K&L Gates Triage: Reading the Fine Print: A Closer Look at the Proposed Regulation over Arbitration Clauses in Long-Term Care...

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This episode discusses CMS’ policy shift regarding binding pre-arbitration dispute clauses in long-term care resident agreements over the course of the past year. CMS’ current proposal reverses the ban on binding pre-dispute...more

Carlton Fields

California Federal Court Allows Indirect Purchasers of Securities to Sue Issuers for Fraud Under California Statute

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A federal magistrate judge in California has allowed a securities fraud suit against a late-stage private company to proceed despite the plaintiff investors holding a security interest only through intermediary,...more

K&L Gates LLP

Pennsylvania Hospitals Successfully Challenge Sequestration Reductions

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In a case of first impression, a Pennsylvania court recently ruled in favor of 12 independent community hospitals (the “Hospitals”) that sued health insurer Highmark Inc. (“Highmark”) for passing on its 2 percent Medicare...more

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