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Medicaid › Appeals

Medicaid is a partnership program between states and the federal government to provide healthcare coverage for lower income individuals, people with disabilities, older people, and certain families with... more +
Medicaid is a partnership program between states and the federal government to provide healthcare coverage for lower income individuals, people with disabilities, older people, and certain families with children.  less -
Weintraub Tobin

California Medi-Cal Enrollment Appeals: An Uphill Battle but an Essential Tool

Weintraub Tobin on

In our practices, we are seeing an increasing number of denials or de facto denials of Medi-Cal provider enrollments. The consequences of a Medi-Cal enrollment denial can be quite serious. First, a provider may not receive...more

White and Williams LLP

Are Syndicated Loans Securities?

White and Williams LLP on

The ongoing case of Kirschner v. JP Morgan Chase Bank, N.A., which has traveled through the New York federal court system since 2018, is now before the Second Circuit, who are tasked with deciding the following: are...more

King & Spalding

Supreme Court Rejects Government's Broad Use of the Aggravated Identity Theft Statute to Impose Two-Year Mandatory Minimum...

King & Spalding on

The aggravated identity theft statute, 18 U.S.C. §1028A, imposes a mandatory two-year sentencing enhancement upon a defendant who “uses” without lawful authority another’s means of identification “during and in relation to”...more

ArentFox Schiff

Investigations Newsletter: Supreme Court Again Tightens FCA Intent, But Tricky Questions Linger

ArentFox Schiff on

The US Supreme Court brushed aside novel assertions from two pharmacy retailers on June 1 and ruled unanimously that False Claims Act liability hinges on whether defendants subjectively believed their claims were “false.” In...more

Kohn, Kohn & Colapinto LLP

The Government’s Ability to Combat Fraud is on the Line in False Claims Act Supreme Court Case

Kohn, Kohn & Colapinto LLP on

Oral arguments are scheduled for April 18, 2023, in the Supreme Court case combining two Seventh Circuit Court of Appeals cases U.S. ex rel. Schutte v. SuperValu, Inc. (“SuperValu”) and U.S. ex rel. Thomas Proctor v. Safeway,...more

King & Spalding

CMS Proposes for the Third Time to Exclude Section 1115 Uncompensated Care Pool Days from Medicare DSH

King & Spalding on

On February 24, 2023, CMS issued a proposed rule that would modify the Medicare Disproportionate Share Hospital (DSH) payment regulation to limit the universe of Section 1115 demonstration beneficiaries who can be “regarded...more

ArentFox Schiff

Investigations Newsletter: DOJ Issues Corporate Self-Disclosure Policy

ArentFox Schiff on

DOJ Issues Corporate Self-Disclosure Policy - The US Department of Justice (DOJ) released a Voluntary Self-Disclosure Policy that sets a consistent standard for corporate self-disclosures for all US Attorney’s Offices. The...more

Bass, Berry & Sims PLC

The ABCs of Medicare and Medicaid Claims Audits: Responding to Audits and Potential Consequences from Negative Audits

Bass, Berry & Sims PLC on

As addressed in the first installment of this three-part series, healthcare providers face potential audits from an increasing number of Medicare and Medicaid contractors. Failing to respond properly can lead to significant...more

King & Spalding

CMS Reworks the Medicare Cost Report for Hospitals

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On December 29, 2022, CMS posted on its website Transmittal 18, which implements sweeping changes to the Medicare cost report for hospitals and its accompanying instructions. The revisions affect nearly every facet of...more

King & Spalding

Supreme Court to Determine Whether False Claims Act Requires Objective Scienter Standard

King & Spalding on

Last week, the Supreme Court granted review to clarify the scienter requirement in False Claim Act (31 U.S.C. §§ 3729 et seq.) (FCA) cases. This significant decision will affect the scope of FCA liability by addressing what...more

Oberheiden P.C.

10 Keys to a Successful Pharmacy Audit Appeal

Oberheiden P.C. on

Medicare, Medicaid, and pharmacy benefit manager (PBM) audits can result in substantial losses for pharmacies. If auditors uncover evidence—or apparent evidence—of overpayments, not only can they initiate recoupments, but...more

King & Spalding

U.S. Supreme Court Will Not Hear Arguments Over Medicaid Work Requirements

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On April 18, 2022, the Supreme Court tossed two consolidated cases from Arkansas and New Hampshire addressing work requirements for Medicaid coverage that required potential Medicaid beneficiaries to work, attend school, or...more

Venable LLP

The Fourth Circuit enforces Safeco's rigorous, objective scienter requirement for Civil False Claims in Sheldon

Venable LLP on

On January 25, in United States ex rel. Sheldon v. Allergan, No. 20-2330 (4th Cir., Jan. 25, 2022), the United States Court of Appeals for the Fourth Circuit upheld a lower-court dismissal of a False Claims Act (FCA) case...more

Mintz - Health Care Viewpoints

False Claims Act Settlements and Judgments Exceed $5.6 Billion in Fiscal Year 2021

Mintz - Health Care Viewpoints on

The Department of Justice announced in a February 1, 2022 press release (Press Release) that it obtained more than $5.6 billion in settlements and judgments from civil cases involving fraud and false claims in the fiscal year...more

Holland & Knight LLP

Florida Medicare and Medicaid Providers' Vaccine Mandate Dilemma

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Florida healthcare providers billing federal programs may again face a complicated COVID-19 quandary. The U.S. Court of Appeals for the Eleventh Circuit has denied the state of Florida's request for an injunction against the...more

Ogletree, Deakins, Nash, Smoak & Stewart,...

Breaking News on the CMS Vaccination Rule: Less Than 24 Hours After Being Shelved in 10 States, the Rule Is Sidelined Nationwide

Ogletree, Deakins, Nash, Smoak & Stewart,... on

In a November 30, 2021, order, a federal judge sitting in Louisiana entered a nationwide preliminary injunction against the Biden administration’s Centers for Medicare and Medicaid Services’ (CMS) interim final rule entitled...more

King & Spalding

Federal COVID-19 Mandates and Lawsuit Roundup

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Lawsuits challenging the CMS Interim Final Rule (IFR) on COVID-19 vaccine requirements for healthcare workers and Occupational Safety and Health Administration’s (OSHA) COVID-19 Emergency Temporary Standards on Health Care...more

DirectEmployers Association

OFCCP Week In Review: November 2021 #2

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The DE OFCCP Week in Review (WIR) is a simple, fast and direct summary of relevant happenings in the OFCCP regulatory environment, authored by experts John C. Fox, Candee Chambers and Jennifer Polcer. In today’s edition, they...more

Dorsey & Whitney LLP

CMS’ COVID-19 Vaccine Mandate: What Health Care Providers Need to Know

Dorsey & Whitney LLP on

Last week, the Centers for Medicare and Medicaid Services (CMS) and the Occupational Safety and Health Administration (OSHA) published their much-anticipated rules mandating COVID-19 vaccinations. ...more

Holland & Knight LLP

Healthcare Law Update: October 2021

Holland & Knight LLP on

Kathryn Isted In Harbor Healthcare System, L.P. v. United States, 5 F.4th 593 (5th Cir. 2021), the court of appeals ruled that the district court abused its discretion in refusing to exercise its equitable jurisdiction over a...more

Dorsey & Whitney LLP

Eight Years Later: “Speculative” and “Straightforward” FCA Allegations Against Walmart Dismissed

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Walmart successfully ended eight years of protracted litigation under the False Claims Act (“FCA”) on June 4, 2021, when the Sixth Circuit affirmed dismissal of Medicare and Medicaid fraud allegations against the major...more

Foley Hoag LLP - Medicaid and the Law

The Avon Nursing Case: A Lesson in Challenging Medicaid Rulemaking for Providers

Foley Hoag LLP - Medicaid and the Law on

Medicaid providers seeking to directly challenge HHS rulemaking recently found success in the 2nd Circuit. In the recent case of Avon Nursing & Rehab v. Becerra, the court sided with a skilled nursing home provider bringing a...more

Dorsey & Whitney LLP

A New Circuit Split: FCA Protects Former Employees from Post-Employment Retaliation in the Sixth

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Over a vigorous dissent last week, a panel of the U.S. Court of Appeals for the Sixth Circuit vacated a ruling from the U.S. District Court for the Eastern District of Michigan and held the False Claims Act’s anti-retaliation...more

Foley Hoag LLP - Medicaid and the Law

The Availability of a Private Right of Action in Medicaid

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A few years ago, we told you about the “ongoing saga” surrounding the ability of a Medicaid beneficiary or a provider of health care services to a Medicaid beneficiary to challenge a state Medicaid agency’s putative violation...more

Dorsey & Whitney LLP

In the First FCA Appellate Case of 2021, the Fourth Circuit Affirms the Dismissal of Relators’ Claims for Lack of Scienter and...

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On January 8, 2021, in the first appellate decision of the year addressing a False Claims Act case, the Fourth Circuit affirmed the summary judgment dismissal of relators’ claims that a manufacturer of allergenic extracts...more

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