On September 30, 2024, a federal district court in Florida held the qui tam enforcement provision of the False Claims Act (“FCA”), which permits private citizens to pursue actions in the name of and on behalf of the...more
10/11/2024
/ Appointments Clause ,
Article II ,
False Claims Act (FCA) ,
Federal Rules of Civil Procedure ,
Florida ,
Medicare ,
Officers of the United States ,
Qui Tam ,
Relators ,
SCOTUS ,
Take Care Clause ,
United States ex rel Polansky v Executive Health Resources Inc
Healthcare systems, hospital networks, and other healthcare providers regularly face challenges that may require an internal investigation to determine the root cause of an issue in order to evaluate how best to remediate and...more
11/12/2019
/ Auditors ,
Audits ,
Best Practices ,
Data Preservation ,
False Claims Act (FCA) ,
Health Care Providers ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Internal Investigations ,
Medicare ,
Overpayment ,
Publicly-Traded Companies ,
Risk Management ,
Witnesses
On June 5, 2018, the Medicare Boards of Trustees (the Board) released its annual report on the fiscal condition of the Medicare trust funds: the Hospital Insurance (HI) trust fund, which supports Medicare Part A, and the...more
On April 24, 2018, the Centers for Medicare & Medicaid Services (CMS) released the Fiscal Year (FY) 2019 Inpatient Prospective Payment System (IPPS) Proposed Rule (CMS-1694-P). Among other changes, CMS proposes eliminating...more
As previously reported, UnitedHealthcare Insurance Company (United) is challenging CMS’s Medicare C/D Overpayment Rule as it applies to Medicare Advantage (MA) organizations. HHS sought to stay United’s lawsuit while it...more
On January 4, 2017, the court in the American Hospital Association (AHA) v. Burwell litigation denied HHS’s motion to reconsider, which means that HHS must comply with the court’s timeline to eliminate the Medicare appeals...more
As previously reported, the American Hospital Association (AHA) filed suit against HHS in 2014 in connection with the Medicare appeals backlog and requested that the court force HHS to meet its statutory deadline for...more
In August 2016, OIG released a series of reports focusing on the Medicaid electronic health record (EHR) incentive program for hospitals in West Virginia, Ohio, and Oklahoma. This continues a recent trend of reports focusing...more
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
8/30/2016
/ 60-Day Rule ,
Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Comptroller ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Hospitals ,
Medicaid ,
Medicare ,
Overpayment ,
Overpayment Recovery Time Limits ,
Whistleblowers