George Breen on Centers for Medicare & Medicaid Services (CMS)

Complex Billing and Reasonable Interpretations: Jury Was Entitled to Find Fraud in Doctor’s Upcoding of Speedy COVID-19 Tests,...

On July 17, 2025, the U.S. Court of Appeals for the Fourth Circuit held that a federal district court was “within bounds to order a do-over” in the case of Ron Elfenbein, a Maryland doctor who was found guilty of...more

8/12/2025 / Appeals , Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Criminal Prosecution , Fraud , Healthcare Fraud , Medicaid , Medical Billing Codes , Medicare , Physicians

Affordable Care Act Overpayments in the CY 2025 Medicare Physician Fee Schedule Proposed Rule: Implications for False Claims

Stakeholders are continuing to analyze the implications of the mammoth proposed rule on “Medicare and Medicaid Programs: [Calendar Year (CY)] 2025 Payment Policies under the Physician Fee Schedule and Other Changes to Part B...more

8/13/2024 / Affordable Care Act , Centers for Medicare & Medicaid Services (CMS) , False Claims Act (FCA) , Health Care Providers , Health Insurance , Healthcare , Medicare Part A , Medicare Part B , Overpayment , Physician Fee Schedule , Proposed Rules , Regulatory Reform

U.S. Department of Justice Announces First Charges Brought Under the Accelerated and Advance Payment Program

On April 8, 2021, the U.S. Department of Justice (“DOJ”) announced the first charges brought in connection with alleged fraud on the Accelerated and Advance Payment Program, administered by the Centers for Medicare & Medicaid...more

5/14/2021 / Accelerated Payments , CARES Act , Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Department of Justice (DOJ) , Healthcare Fraud , Paycheck Protection Program (PPP) , Provider Relief Fund

New Program Integrity Rule Expanding Medicare Revocation and Denial Authorities Took Effect Yesterday

Yesterday, a final rule issued by the Centers for Medicare & Medicaid Services (CMS) establishing new enforcement initiatives aimed at removing and excluding previously sanctioned entities from Medicare, Medicaid, and the...more

11/5/2019 / Affiliates , Bad Actors , Centers for Medicare & Medicaid Services (CMS) , Children's Health Insurance Program (CHIP) , Durable Medical Equipment , Enrollment , Health Care Providers , Healthcare Fraud , Healthcare Reform , Medicaid , Medicare , Revocation , Suppliers

Arrangements, Exceptions and Modifications- OIG and CMS Challenge the Status Quo

The Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services Office of Inspector General (OIG) issued their long-awaited proposed rules in connection with the Regulatory Sprint to...more

10/10/2019 / Anti-Kickback Statute , Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Health Care Providers , Healthcare Reform , OIG , Safe Harbors , Value-Based Care

CMS Issues Long-Awaited Rule Regarding Reporting and Returning Overpayments

Section 6402(a) of the Affordable Care Act (“ACA”), which was enacted by Congress in 2010, requires a person who has received an overpayment to report and return the overpayment to the Secretary of Health and Human Services,...more

2/19/2016 / Affordable Care Act , Centers for Medicare & Medicaid Services (CMS) , Final Rules , Medicare , Overpayment Recovery Time Limits

The Clock’s Running Fast: SDNY Is First to Interpret “Identification” Under the FCA’s “60-Day Rule” for Government Overpayments

On August 3, 2015, in United States ex rel. Kane v. Healthfirst, Inc., et al., No. 1:11-cv-02325 (S.D.N.Y. Aug. 3, 2015), the United States District Court for the Southern District of New York issued the first reported...more

8/11/2015 / Affordable Care Act , Centers for Medicare & Medicaid Services (CMS) , Defense Strategies , False Claims Act (FCA) , Health Care Providers , Healthcare , Medicaid , Medicare , Overpayment , Qui Tam

CMS Issues Final Rule Designed to Enhance Agency Oversight of Medicare Providers and Strengthen Protections for Medicare...

On December 3, 2014, the Centers for Medicare & Medicaid Services (“CMS”) issued a final rule (CMS-6045-F) that updates various requirements for providers and suppliers wishing to enroll in the Medicare program. CMS issued...more

12/12/2014 / Affordable Care Act , Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicare

George Breen

Epstein Becker & Green

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