News & Analysis as of

Final Rules False Claims Act (FCA) Medicare

Kaufman & Canoles

Medicare’s 60-Day Rule

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The Centers for Medicare & Medicaid Services (CMS) finalized significant updates to the Medicare 60-Day Rule, which governs how providers and organizations must handle overpayments. Taking effect January 1, 2025, these...more

Proskauer - Health Care Law Brief

CMS Publishes Final Rule, Effective January 1, 2025, Addressing the Requirements for Reporting and Returning Overpayments

The standard for an “identified overpayment” under Medicare Parts A–D now aligns with section 1128J(d)(4)(A) of the Social Security Act, which incorporates by reference the Federal False Claim Act’s (the “FCA”) “knowledge”...more

Burr & Forman

Failure to Return Credit Balances (Especially to Medicare and Medicaid) Can Create Significant Liability

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Every health care provider has “credit balances,” which occur when a provider receives more money than it is owed for services rendered. Credit balances can be caused by a number of factors, including incorrect coding,...more

Goodwin

Watch the Clock! CMS Makes Important Changes to Medicare Overpayment Rules

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The Centers for Medicare & Medicaid Services (CMS) recently made meaningful changes to its regulations interpreting the Affordable Care Act’s (ACA’s) so-called “60-day Rule,” which requires Medicare providers to affirmatively...more

Robinson+Cole Health Law Diagnosis

CMS Finalizes Standard for Identifying Overpayments and Grace Period for Investigations of Related Overpayments

As part of its 2025 Physician Fee Schedule Final Rule (PFS Rule), the Centers for Medicare & Medicaid Services (CMS) finalized two crucial updates to federal Medicare overpayments regulations (sometimes referred to as the...more

Holland & Knight LLP

Final Medicare Overpayment Rules a Mixed Bag for Providers

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The Centers for Medicare & Medicaid Services (CMS) released highly anticipated updates this month to the Medicare regulations interpreting the federal 60-day overpayment refund requirement (the Overpayment Statute). The...more

Foley & Lardner LLP

Medicare Overpayments: CMS Issues Final Regulations Implementing Changes to 60-day Refund Rule

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On Friday, November 1, 2024, the Center for Medicare & Medicaid Services (CMS) issued the display copy of the final rule interpreting the 60-day Refund Rule for Medicare Parts A/B (Traditional Medicare) and C/D (Medicare...more

McDermott Will & Emery

Healthcare Regulatory Check-Up Newsletter | July 2024 Recap

This issue of McDermott’s Healthcare Regulatory Check-Up highlights regulatory activity for July 2024. We discuss several US Department of Health and Human Services (HHS) agency actions, including a final rule on provider...more

Proskauer - Health Care Law Brief

New HIPAA Requirements Place Additional Privacy Obligations on Covered Entities and Patients in an Effort to Protect Reproductive...

On April 22, 2024, the Office for Civil Rights (OCR) for the United States Department of Health and Human Services issued a Final Rule amending the Privacy Rule of the Health Insurance Portability and Accountability Act...more

Nelson Mullins Riley & Scarborough LLP

Internal Investigations are a MUST for Avoiding False Claims Act Liability

Many providers are not familiar with their obligations under the “60 Day Rule,” also known as Reverse False Claims liability, which can cause significant financial harm if providers fail to comply with these obligations....more

Benesch

Dialysis & Nephrology Digest - March 2021

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Fresenius to defend itself from FCA suit following whistleblower allegations - A former employee alleges Fresenius engaged in arrangements with hospitals and nephrologists to ensure patient referrals to its dialysis...more

ArentFox Schiff

Investigations Newsletter: HHS Announces Final Rules Amending Stark Law Regulations and Anti-Kickback Statute

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HHS Announces Final Rules Amending Stark Law Regulations and Anti-Kickback Statute - On November 20, 2020, the Centers for Medicare and Medicaid Services and the Department of Health and Human Services (HHS) published...more

Health Care Compliance Association (HCCA)

Report on Medicare Compliance Volume 29, Number 3. News Briefs: January 2020 #3

Report on Medicare Compliance 29, no. 3 (January 27, 2020) - Mission, Texas, rheumatologist Jorge Zamora-Quezada, M.D., was found guilty by a jury Jan. 15 for his part in a $325 million heath fraud scheme in which he...more

Holland & Knight LLP

Healthcare Law Update: July 2019

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CMS Regulation - District Court Strikes Down Rule Mandating Price Disclosure in DTC Pharmaceutical Advertisements - The U.S. Department of Health and Human Services (HHS), together with the Centers for Medicare &...more

Bradley Arant Boult Cummings LLP

2016 – Health Law Year in Review

We are pleased to present our annual review of developments in the field of health law. The year was marked by key changes in False Claims Act jurisprudence and Medicare payment policy. 2016 also brought with it focused...more

Dickinson Wright

Physician Compliance Programs: What you need to know about the Final 60-Day Rule

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The 60-Day Rule was enacted as part of the Affordable Care Act on March 23, 2010 and generally requires a person who has received an overpayment to report and return the overpayment by the later of (i) the date which is 60...more

Harris Beach PLLC

Health Care Group News: Final Rule Regarding Return Of Medicare Overpayments Is More Favorable to Providers Than Anticipated

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One element of the Affordable Care Act (ACA), enacted in March 2010, requires providers to identify, report and return Medicare overpayments. A provider’s failure to do so can result in False Claims Act liability, Civil...more

Baker Donelson

Final 60-day Overpayment Rule

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On February 12, 2016, CMS published a final rule addressing compliance with Section 1128J(d) of the Social Security Act. Section 1128J(d), which was added when the Affordable Care Act was enacted on March 23, 2010, imposes a...more

Dorsey & Whitney LLP

CMS Finalizes Rule Requiring Healthcare Providers to Return Overpayments

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On February 12, 2016, the Centers for Medicare & Medicaid Services (CMS) published its final rule regulating how healthcare providers must report and return overpayments. This rule implements the Affordable Care Act’s...more

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