Hospice Insights Podcast - Meet the New Laws, Same as the Old Laws: Overpayment Recoupment Update
PODCAST: Williams Mullen's Benefits Companion - SECURE 2.0 Act - More Relief for Plan Administrators
Recent Tenth Circuit Decision in John Q Hammons Fall Following SCOTUS’ Decision in Siegel v. Fitzgerald Could Result in Significant Refunds for Certain Chapter 11 Debtors
Nuts and Bolts of a Repayment Investigation: Keys to Conducting Investigations Under the 60-Day Repayment Rule
Hospice Audit Series: The Latest Developments and Strategies for Success in the Ever-changing Audit Landscape
The Office of the Inspector General (OIG) continues to focus on Medicare Advantage (MA) risk adjustment payments, issuing a report this week detailing its audit of MA risk adjustment payments based on acute stroke diagnosis...more
The Department of Justice recently ramped up healthcare fraud investigations and prosecutions and shows no intention of slowing down. Indeed, the DOJ’s recent settlement with Oglethorpe, Inc. and its top executives offers key...more
Foley & Lardner LLP (Foley) secured a fully favorable Administrative Law Judge (ALJ) decision overturning $3,261,046.50 in Medicare overpayments assessed by the Centers for Medicare & Medicaid Services (CMS) against a Florida...more
Over the past 18 months, regulatory oversight, government investigations and recoupment actions relating to wound care, generally, and skin substitutes, specifically, have increased dramatically. A combination of the United...more
In a decision closely followed for its impact on workers’ compensation claims, the Tenth District Court of Appeals in State ex rel. Kurtz v. Indus. Comm., 2026-Ohio-824, addressed two issues:...more
On March 12, 2026, the Department of Treasury and the IRS released proposed regulations to update and clarify several provisions in the arbitrage regulations under Section 148 of the Internal Revenue Code. The proposed...more
On December 16, 2025, the Office of Inspector General (“OIG”) for the U.S. Department of Health and Human Services (“HHS”) published the results of its audit of a Louisiana-based Medicare Advantage contract for Humana, the...more
Effective January 1, 2026, new Florida legislation imposes strict requirements on healthcare facility licensees and practitioners to refund patient overpayments within a specified timeframe. The law introduces clear...more
Physicians and entities to which physicians refer may violate the Ethics in Patient Referrals Act (“Stark”) by mistakenly overpaying or underpaying amounts due under a compensation arrangement. For example, a hospital may...more
The U.S. Fifth Circuit Court of Appeals recently reversed a Texas district court’s denial of class certification in the case of Wilson v. Centene Management. In the litigation, three Texans filed suit against Centene...more
The Florida Regular Legislative Session began on March 4, 2025, and ended on June 6, 2025. Below is a summary of health care legislation scheduled to take effect upon becoming law, contingent on constitutional procedure. The...more
Don’t sit on those patient credits. Effective January 1, 2026, a new Florida law (CS/CS/SB 1808) requires licensed health care facilities, providers, and practitioners (each, a “Licensed Provider”) to refund any overpayment...more
A federal appeals court just illustrated the importance of an employer’s duty to monitor service providers that assist with the administration of employee welfare benefit plans. In the May 21 decision of Tiara Yachts v. Blue...more
Mistakes happen, even with sophisticated corporate payroll systems. This can involve duplicate wage payments, paying an employee for unpaid time away from work, or other genuine errors. ...more
This issue of McDermott’s Healthcare Regulatory Check-Up highlights key regulatory and enforcement activity for March 2025. This month features: - Noteworthy enforcement actions demonstrating that the Anti-Kickback Statute...more
On February 26, 2025, the U.S. District Court for the Northern District of Texas issued a significant False Claims Act (FCA) ruling in United States of America ex rel. Cheryl Taylor v. Healthcare Associates of Texas, LLC,...more
Under SECURE 2.0, plan sponsors were granted discretion to determine whether or not the plan would recoup "inadvertent benefit overpayments." However, SECURE 2.0, did not define the term, leaving implementation of the new...more
The health care regulatory space realized significant regulatory and enforcement developments in 2024 that are influencing how providers and industry stakeholders approach various compliance measures and enforcement...more
First Circuit Joins Sixth and Eighth Circuits in Adopting Heightened, But-For Causation Standard for AKS-Based FCA Claims - On February 18, the US Court of Appeals for the First Circuit became the latest court to agree...more
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
Providers are required by federal law to return Medicare and Medicaid overpayments within 60 days of identifying the overpayment or they can be liable under the False Claims Act. Since 2016, providers have relied on Centers...more
As government scrutiny and enforcement targeting the Medicare Advantage (Medicare Part C) program continued in 2024, the industry’s response to agency actions escalated. Last year also resulted in the first sizable Part D...more
The Centers for Medicare & Medicaid Services issued its long-anticipated final rule clarifying the 60-day overpayment refund obligation (the 60-Day Rule) first established in a 2016 regulation for Medicare Part A and B...more
On November 1, 2024, the Centers for Medicare & Medicaid Services (CMS) finalized the Medicare regulations interpreting the federal 60-day overpayment refund requirement (the Overpayment Statute) for Medicare Parts A and B as...more
In November 2024, the Centers for Medicare & Medicaid Services (“CMS”) released a final rule addressing, among other things, the Medicare Parts A and B overpayment provisions of the Affordable Care Act (the “Final Rule”). It...more