News & Analysis as of

Overpayment Medicare

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

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

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

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

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

Lincoln’s Law Becomes Even More Absurd When Applied to the Health Care Industry

by Ruder Ware on

When Congress originally passed the False Claims Act (31 USC §§ 3729-3733), no one had the health care system in mind. The False Claims Act was also commonly referred to as the “Lincoln Law”. The original law was focused on...more

CMS's Payment Suspensions Wreak Havoc: Understanding the Risks

by Baker Ober Health Law on

CMS payment suspensions can cripple any provider's or supplier's operations. Yet, CMS has the authority to impose a payment suspension upon the mere existence of "reliable information" that an overpayment or fraud may exist....more

Raising Kane: CMS’s 60-Day Rule Commands More Than Treble Damages

by Alston & Bird on

In August 2015, we published a client advisory on the first judicial opinion interpreting the Affordable Care Act’s (ACA) “60-day overpayment rule,” which requires providers to “report and return” an overpayment of Medicare...more

The Top 10 Things you Need to Know About Voluntary Disclosures and Government Refunds

by Foley & Lardner LLP on

In February 2016, CMS issued the highly anticipated Final Rule on reporting and returning Medicare Part A and B overpayments. The Final Rule was meant to clear up some of the confusion among providers regarding such...more

60-Day Overpayment FCA Enforcement Action Results in $2.95 Million Settlement

by King & Spalding on

On August 23, 2016, a New York hospital system settled False Claims Act (FCA) allegations that it violated the 60-day overpayment rule by improperly retaining Medicaid overpayments. The whistleblower alleged that three of the...more

The Overpayment Rule and the Implied False Claims Theory: “What You Don’t Know Can Still Hurt You”

In 2010, the Affordable Care Act (“ACA”) enacted new rules governing overpayments made by the Medicare and Medicaid programs. Under these rules, providers have 60 days from the date that the overpayment has been identified to...more

CMS Steps Up Efforts to Recover Overpayments from Providers/Suppliers Sharing TINs

by Reed Smith on

CMS has just announced that it has enhanced its financial accounting system to allow it to recover Medicare payments made to a provider or supplier that shares the same Tax Identification Number (TIN) with a provider or...more

OIG Identifies Continued Vulnerabilities in Medicare Provider-Based Facility Payment Policy

by Reed Smith on

A new OIG report examines CMS’s oversight of Medicare billing by provider-based facilities – that is, facilities that operate under the ownership, administrative, and financial control of a hospital and meet other...more

CMS Announces Plans to Streamline the Stark Self-Referral Disclosure Protocol

by Baker Ober Health Law on

On May 6, 2016, CMS published a notice (Notice), required under the Paperwork Reduction Act (PRA), seeking public comment on its plans to revise the information collected under the Medicare Self-referral Disclosure Protocol...more

CMS Seeks Comment on Self-Disclosure Protocol Form

by King & Spalding on

On May 6, 2016, CMS published an information collection request notice regarding the existing Medicare self-referral disclosure protocol (SRDP). Specifically, CMS intends to streamline the current SRDP and revise the...more

CMS Unveils Revised Voluntary Self-Referral Disclosure Protocol

On May 6, 2016, the Centers for Medicare and Medicaid Services (CMS) released proposed revisions to its Voluntary Self-Referral Disclosure Protocol (SRDP), through which providers may disclose actual or potential violations...more

A&B Healthcare Week in Review

by Alston & Bird on

I. REGULATIONS, NOTICES, & GUIDANCE - On April 15, 2016, the Food and Drug Administration (FDA) issued a proposed rule entitled, “Applications for Approval and Combinations of Active Ingredients Under Consideration for...more

Health Law Insights Newsletter - Issue 7 - March 2016

by McCarter & English, LLP on

McCarter & English, LLP’s Health Care Group presents Issue 7 of the Health Law Insights, which discusses the latest legal issues in the health care industry. NATIONAL - Providers’ Obligation to Report Medicare...more

Final Rule on refund of Medicare overpayments: Key requirements to know

by Thompson Coburn LLP on

The long awaited Final Rule on return of Medicare overpayments (Final Rule) issued by the Centers for Medicare & Medicaid Services (CMS) took effect on March 14, 2016. The Final Rule applies to Medicare Part A and Part B...more

Program Integrity Changes to the Medicare Provider Enrollment Process

by McDermott Will & Emery on

On March 1, 2016, the U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services (CMS) published a proposed rule (Proposed Rule) entitled “Medicare, Medicaid, and Children’s Health Insurance...more

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

by Dickinson Wright on

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

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

by Murtha Cullina on

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

CMS Issues Long-Awaited Final 60-Day Overpayment Rule

by King & Spalding on

On February 11, 2016, CMS released its eagerly awaited final overpayment rule for Parts A and B. The Final Rule responds to significant concerns voiced by the provider community and, in some respects, is more workable than...more

Final 60-day Overpayment Rule

by Baker Ober Health Law on

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

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