Recently, Optum Behavioral Health (“Optum,” the services division for UnitedHealth Group) has initiated overpayment recovery actions against numerous licensed clinical social workers (“LCSWs”) across the country for services...more
The end of 2021 brings positive indications of the continued acceptance of telehealth as an important clinical care approach post public health emergency (“PHE”). The Centers for Medicare and Medicaid Services (“CMS”), like...more
2/22/2022
/ Ambulatory Surgery Centers ,
Centers for Medicare & Medicaid Services (CMS) ,
Drug Pricing ,
Health Care Providers ,
Health Insurance ,
Healthcare ,
Healthcare Reform ,
Inpatient Prospective Payment System (IPPS) ,
Medicaid ,
Medical Reimbursement ,
Medicare ,
Medicare Advantage ,
Outpatient Prospective Payment System (OPPS) ,
Payor Contracts ,
Physician Fee Schedule ,
Section 340B ,
Surprise Medical Bills ,
Telehealth
On March 15, 2020, Alex Azar, Secretary of the Department of Health and Human Services (“HHS”) issued Waiver or Modification of Requirements Under Section 1135 of the Social Security Act, available. ...more
On October 31, 2019, the Office of General Counsel for the U.S. Department of Health and Human Services (HHS) issued an important memo from Kelly M. Cleary, CMS Chief Legal Officer, and Brenna E. Jenny, Deputy General...more
12/5/2019
/ Administrative Procedure Act ,
Azar v Allina Health Services ,
Centers for Medicare & Medicaid Services (CMS) ,
Denial of Benefits ,
Department of Health and Human Services (HHS) ,
False Claims Act (FCA) ,
Health Care Providers ,
Hospitals ,
Local Coverage Determination (LCD) ,
Low-Income Issues ,
Medicare ,
Medicare Advantage ,
Medicare Part A ,
Medicare Part C ,
Notice and Comment ,
Overpayment ,
Pay Reductions ,
Provider Payments ,
Reaffirmation ,
Retroactive Application ,
Rulemaking Process ,
SCOTUS ,
Substantive Rule ,
Universal Health Services Inc v United States ex rel Escobar ,
Vacated
The U.S. Department of Health and Human Services (HHS) released a Final Rule aimed at reducing and eventually eliminating the backlog of more than 650,000 claims currently awaiting adjudication by an administrative law judge...more
2/17/2017
/ Adjudicatory Process ,
Administrative Law Judge (ALJ) ,
Amount in Controversy ,
Centers for Medicare & Medicaid Services (CMS) ,
Decision-Making Process ,
Department of Health and Human Services (HHS) ,
Final Rules ,
Medicare ,
Medicare Advantage ,
Medicare Appeals Council ,
Medicare Claims Appeals Process ,
OMHA ,
Redeterminations