News & Analysis as of

Dept. of Justice Centers for Medicare & Medicaid Services

The United States Department of Justice is a federal executive department established in 1870 by federal statute. The Department is headed by the Attorney General and is responsible for administering and... more +
The United States Department of Justice is a federal executive department established in 1870 by federal statute. The Department is headed by the Attorney General and is responsible for administering and enforcing federal law. The Department is compromised of many different divisions which handle a wide variety of civil and criminal issues.    less -

CMS to Revise Coverage For Implanted Cardiac Devices

by King & Spalding on

On November 20, 2017, CMS announced proposed updates to the coverage policy for Implantable Cardioverter Defibrillators (ICDs). The proposed changes would be the first major update to ICD coverage in over a decade. Over the...more

Window on Washington - Vol. 1, Issue 35

by Clark Hill PLC on

Ryan Hints at Short-Term Spending Bill: Speaker Paul Ryan (R-Wis.) on Tuesday said Republicans might need a short-term spending bill to prevent a government shutdown on December 9. Ryan said the House GOP's goal is to pass a...more

Unreliable Expert Collapses DOJ-Led False Claims Act Case

by Holland & Knight LLP on

False Claims Act cases often turn into battles of the experts. But only rarely does that battle turn into a rout. It did last week in a case out of the Eastern District of Virginia, United States ex rel. Ribik v. HCR...more

Window on Washington - Vol. 1, Issue 34

by Clark Hill PLC on

Short-term Continuing Resolution Likely Needed to Fund Government Past December Deadline: Republicans are focused on tax reform through Thanksgiving, and when lawmakers return from the upcoming holiday recess, they will have...more

Justice Department Abandons Medicare Advantage FCA Suit Against UnitedHealth

On October 13, 2017, the U.S. Department of Justice (DOJ) decided to abandon its lawsuit accusing UnitedHealth Group and affiliated health plans (UnitedHealth) of exaggerating how sick its patients were to procure millions of...more

Under What Circumstances Can a Private Qui Tam Plaintiff Overrule Government Agency Experts' Use of Administrative Discretion to...

• How have appellate courts applied the Supreme Court’s ruling in Escobar? • If the government is aware of the relator’s allegation, but does not undertake any administrative action to address the defendant’s alleged...more

Window On Washington - This Week in the Nation's Capital - Issue 29

by Clark Hill PLC on

Hurricane Supplemental Includes $29B for Disaster Aid and Flood Insurance: Of the $29B, the National Flood Insurance Program will receive $16B to pay flood claims. The House plans to pass the bill next week and the Senate the...more

A Year Into the Elder Justice Task Force: Is Your Community a Target?

by Baker Ober Health Law on

On March 30, 2016, the Department of Justice issued a press release announcing its launch of ten Elder Justice Task Forces in the Northern District of California, Northern District of Georgia, District of Kansas, Western...more

Healthcare Law Update: September 2017

by Holland & Knight LLP on

OIG Advisory Opinions - Manufacturer's Free Replacement of Spoiled Pharmaceutical Products Authorized - On Aug. 25, 2017, the U.S. Department of Health and Human Services' (HHS) Office of Inspector General (OIG)...more

Reminder: Medical Providers Must Be Attentive to Credit Balances and Other Overpayments

It has now been a number of years since the enactment of Section 6402(a) of the Affordable Care Act ("ACA"), which requires among other things that any recipient of a Medicare or Medicaid overpayment report and return it...more

What Is The Value of Cooperation With the SEC?

by Dorsey & Whitney LLP on

The Commission has long encouraged firms and individuals to cooperate with its investigations based on the promise of consideration when the action is resolved. When the resolution is reached the agency may acknowledge the...more

Client Alert: Feds Shine a Light on Medicare Advantage Plans and Physicians Related to Risk Adjustment Practices

Although the sufficiency of medical records documentation supporting beneficiary diagnoses for Medicare Advantage (MA) risk adjustment has been on the OIG’s work plan since 2013, the Department of Justice has upped the ante...more

Second DOJ Complaint: Knowledge of Invalid Codes Requires Follow-Through to Avoid Liability

by Bass, Berry & Sims PLC on

The DOJ’s recent complaint-in-intervention in US ex rel. Poehling v. United Health Group — one of two qui tam cases against United Health currently pending in the Central District of California — emphasizes the government’s...more

OIG Reports More Than $731 Million in Inappropriate Medicare Meaningful Use Payments

by McDermott Will & Emery on

The Electronic Health Records (EHR) Incentive Program run by Centers for Medicare and Medicaid Services (CMS) garnered attention again last week following the release of a report by the Office of Inspector General of the US...more

"Meaningfully Useful" Risk Mitigation Strategies for Providers Following the eClinicalWorks Settlement

by Jones Day on

The Health Information Technology for Economic and Clinical Health Act ("HITECH Act") established financial incentives under Medicare and Medicaid for eligible health care providers that adopt, implement, and demonstrate use...more

DOJ’s New Healthcare Fraud Target—Medicare Advantage Insurers

by Blank Rome LLP on

The government continues to seek ways to rein in healthcare costs. Now it has set its sights on the Medicare Advantage Program. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private...more

The Enforcement Risks for Medicare Advantage Plans Continue: A New False Claims Act Settlement in Florida

Recent activities of the Department of Justice (“DOJ”) and Qui Tam whistleblowers reveal that Medicare Advantage Plans remain at the forefront of investigations for violations of the federal False Claim Act (“FCA”) for...more

The Latest in the Epipen Medicaid Drug Rebate Saga – Where Are We Now?

The latest installment in the ongoing saga over EpiPen Medicaid Drug Rebates came on May 31, 2017, when Senator Charles Grassley issued a press release stating that between 2006-2016 taxpayers may have overpaid for EpiPen by...more

An Unsettling Settlement: Health Plan to Pay $32 Million to Settle Coding and Provider Network Misrepresentation Charge

by Faegre Baker Daniels on

On May 30, the Department of Justice (DOJ) announced that it reached a settlement with commonly-owned Freedom Health Inc. and Optimum Healthcare, Inc. (Freedom Health) — two Tampa, Florida, managed care plans — to settle...more

The DOJ Enters Another FCA Lawsuit Against UnitedHealth

by BakerHostetler on

The U.S. Department of Justice (DOJ) recently filed its complaint in intervention in another whistleblower lawsuit brought under the False Claims Act against the nation’s largest owner and operator of Medicare Advantage (MA)...more

Medicare Advantage Plans Under Fire: The Department of Justice Files Complaints-in-Intervention

As reported in earlier blogs, the federal Department of Justice (DOJ) has been actively looking into potential abuses by Medicare Advantage (MA) Organizations as to allegedly improper risk adjustment claims submissions and...more

Health Update - April 2017

CMS Issues Self-Referral Disclosure Protocol for Stark Law Violations - On March 28, 2017, the Centers for Medicare & Medicaid Services (CMS) issued a new voluntary self-referral disclosure protocol (SRDP) for disclosing...more

Justice Department Joins Whistleblower Suit Accusing UnitedHealth Group of Overcharging Medicare by “Hundreds of Millions”

The U.S. Department of Justice (DOJ) has joined a whistleblower lawsuit, United States of America ex rel Benjamin Poehling v. Unitedhealth Group Inc., No. 16-08697 (Cent. Dist. Cal. Sep. 17, 2010), ECF No. 79, against...more

Health Update - February 2017

Securing the Safety Net for America's Vulnerable Populations - Editor's Note: America's population is aging rapidly. By 2029, 75 million baby boomers will have reached age 65 and older, and older adults will represent...more

Aetna-Humana Merger Blocked

by Pierce Atwood LLP on

The District of Columbia federal court recently ruled that a proposed $37 billion merger between health insurance giants Aetna and Humana cannot proceed, granting the US Department of Justice’s bid to block the combination on...more

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