News & Analysis as of

Overpayment

Repayment Delay Fuels Whistleblower Settlement

On October 13, 2017, the United States Department of Justice (DOJ) revealed that First Coast Cardiovascular Institute, P.A. (FCCI) entered into a Settlement Agreement with the federal government and the State of Florida...more

Further ESOP Transaction Guidance Set Forth in Latest DOL Settlement Agreement

by Holland & Knight LLP on

On the heels of a recent settlement agreement with an institutional employee stock ownership plan (ESOP) trustee, the U.S. Department of Labor (DOL) and individual trustee James F. Joyner III (Joyner) entered into a...more

The Rise of Managed Care Audits and Reimbursement Demands in the Wake of the ACA

If the summer of 2017 demonstrated anything, it is that health care remains a complex and contentious industry. One of its many complications stems from the natural tension between health care providers and health care...more

Baldwin County Circuit Court Dismisses ADOR’s Appeal in Moody

Two weeks ago, the Baldwin County Circuit Court entered an order dismissing the Alabama Department of Revenue’s (ADOR) appeal from the February 2017 decision by the Alabama Tax Tribunal in Moody v. Alabama Department of...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

Sixth Circuit: Technical Physician Signature Deficiencies not "Material" to Reimbursement Claims

by Jones Day on

The District Court for the Middle District of Tennessee held on June 22, 2017, that the timing requirements related to a physician's certification of need for home health services were not "material" to the Centers for...more

Pensions Ombudsman round-up: May 2017 (UK)

by DLA Piper on

Welcome to DLA Piper’s Pensions Ombudsman Round-Up publication in which we report on recent determinations made by the Pensions Ombudsman (“PO”) and Deputy Pensions Ombudsman (“DPO”). In this edition we look at...more

Preventing Overpayments from becoming False Claims

by Dickinson Wright on

Overpayments to healthcare providers receiving Medicare reimbursements are at risk of civil and criminal enforcement action if not attuned to a particular reimbursement rule and diligent in compliance with the rule’s...more

Applying Overpayments of Tax to Tax and the Offshore Penalty in the OVDP Program

by Charles (Chuck) Rubin on

The OVDP program allows taxpayers to remedy deficient disclosure filings relating to offshore accounts for a fixed penalty amount. As part of the program, taxpayers must file either original or amended tax returns which...more

Repayment and Self Disclosure of Known Overpayments

by Ruder Ware on

The 60-day repayment rule adopted as part of the Affordable Care Act is a very strong arrow in the quiver of federal enforcement agencies. Under the 60-day rule a known overpayment can become a False Claim if it is not repaid...more

D.C. District Court Allows Part C Plan to Continue with Challenge of Overpayment Rule

by King & Spalding on

On March 31, 2017, Judge Rosemary Collyer of the United States District Court for the District of Columbia held that plaintiffs UnitedHealthcare Insurance Company et al. (“United”) had standing to challenge CMS’s overpayment...more

Can Overpayments Create Criminal Liability?

by Ruder Ware on

We hear a lot about potential liability under the False Claims Act (FCA) for the failure to repay overpayments within 60 days of discovery. Focus on the 60-day rule has taken focus away from the potential for criminal charges...more

Three Recent Fraud Cases Involving Dermatologists Illustrate Primary Compliance Risks in Dermatology Practices

by Ruder Ware on

Three relatively recent cases involving dermatology billing practices illustrate some of the main compliance risks faced by dermatology practices...more

Minnesota Federal Court Says Cross-Plan Offsets Are Unlawful; Certifies Case for Immediate Appeal

by Cozen O'Connor on

The U.S. District of Minnesota has ruled in Peterson v. Unitedhealth Grp. Inc., No. 14-CV-2101 (PJS/BRT), 2017 WL 991043 (D. Minn. Mar. 14, 2017) that ERISA does not permit United Healthcare (“United”) to claw back alleged...more

Capital Formation Bills Approved by House and Senate Committees

On March 9, 2017, a number of bipartisan bills designed to promote capital raising for companies were approved by the House Financial Services Committee and the Senate Committee on Banking, Housing and Urban Affairs. ...more

Chiropractic Service Overpayment for Lack of Medical Necessity

by Ruder Ware on

Recent OIG Release Emphasizes Need for Compliance Policies Specific to Provider Risks The Office of Inspector General recently published results of its audit of Medicare claims for chiropractic services made by a chiropractic...more

KL Snapshot #12 – Janvier-Février 2017

Banque & Finance – Hubert de Vauplane - Rapport Terra Nova : Les conflits d'intérêts, nouvelle frontière de la démocratie de février 2017 - Hubert De Vauplane a été auditionné le 20/03/15 dans le cadre de la...more

Pensions Ombudsman round-up: January 2017 (UK)

by DLA Piper on

Welcome to DLA Piper’s Pensions Ombudsman Round-Up publication in which we report on recent determinations made by the Pensions Ombudsman (“PO”) and Deputy Pensions Ombudsman (“DPO”). In this edition we look at...more

Texas OIG Turns Over New Leaf: MCOs Must Turn Attention to SIUs

by Strasburger & Price, LLP on

More active SIUs may mean more scrutiny of Medicaid providers - The Texas Office of Inspector General (OIG) has just completed its first full year of reforms under a new Inspector General. 2017 may reveal whether these...more

False Claims Act: 2016 Year in Review

We are pleased to present Bradley’s annual review of significant False Claims Act (FCA) cases, developments, and trends. From a relatively short article several years ago, the Review has grown to a significant publication...more

A Liar and A Cheat? 3 Ways to Pay...

by Seyfarth Shaw LLP on

Seyfarth Synopsis: Insurer gets to pick its remedy when hospital engages in dishonest billing and illegal kickbacks…to the tune of $41 million. Judge Lynn Hughes of the U.S. District Court for the Southern District of...more

Tax Litigation Update – Fall 2016

by King & Spalding on

Tax Court Denies Commissioner’s Motion to Compel After Predictive Coding Used to Identify Responsive Documents - On July 13, 2016, Judge Ronald Buch of the Tax Court denied the Commissioner’s motion to compel Dynamo...more

Medical Litigation Newsletter - December 2016

by Hinshaw & Culbertson LLP on

Defending Audits Before They Happen: A Practical Guide to Documenting to Sustain A Challenge to E/M Codes - Although many believe malpractice suits to be the primary risk-management issue facing healthcare providers, an...more

Pensions Ombudsman Round-Up - November 2016 (UK)

by DLA Piper on

Welcome to DLA Piper’s Pensions Ombudsman Round-Up publication in which we report on recent determinations made by the Pensions Ombudsman (“PO”) and Deputy Pensions Ombudsman (“DPO”). In this edition we look at...more

Brookdale To Pay Nearly $1 Million To Settle Allegations Of Overbilling Government Programs

On November 21, 2016 Brookdale Senior Living, Inc., the largest senior housing provider in the United States, agreed to pay $979,000 to settle allegations that Emeritus Corporation failed to refund to the federal and several...more

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