News & Analysis as of

Administrative Law Judge (ALJ) Department of Health and Human Services (HHS) Health Care Providers

Polsinelli

Back to Backlog? Polsinelli Shareholders Share Insight on how Terminations of DAB Attorneys and Potential Removal of...

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As the new administration continues its efforts to contract and streamline the federal government, recent developments at the U.S. Department of Health and Human Services (“HHS”) and the Department of Justice (“DOJ”) hint at...more

BakerHostetler

DSIR Deeper Dive: Tracking the Crackdown on Tracking/Pixel Technologies: Web Litigation and Regulatory Landscape - Part 2

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In the first part of this blog post, we looked into the OCR and FTC’s focus on third-party tracking technologies. We also reviewed the AHA Lawsuit and its impact for the use of tracking technologies. In this blog post, we...more

Health Care Compliance Association (HCCA)

DAB Affirms OIG's $1.32M Penalty on Provider for Breaching CIA

Report on Medicare Compliance 29, no. 23 (June 22, 2020): The HHS Departmental Appeals Board (DAB) has upheld the largest stipulated penalty imposed by the HHS Office of Inspector General (OIG) in years. OIG fined...more

King & Spalding

Senators Grassley and Wyden Reintroduce Legislation to Reduce Medicare Appeals Backlog

King & Spalding on

On December 17, 2019, Senate Finance Committee Chairman Chuck Grassley (R-Iowa) and Ranking Member Ron Wyden (D-Ore.) reintroduced legislation to address the backlog of Medicare appeals cases awaiting review before an...more

Arnall Golden Gregory LLP

Texas Court Holds That Medicare Payment Suspensions Cannot Be Challenged In Federal Court

When the Centers for Medicare and Medicaid Services (CMS), through a Medicare contractor, conducts a post-payment audit of a provider’s Medicare reimbursements and determines that the provider may have received an...more

Baker Donelson

OIG's List of Excluded Individuals/Entities – What Employers Need to Know

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OIG maintains a list of all currently excluded individuals and entities called the "List of Excluded Individuals/Entities," or LEIE. Covered entities that hire – or continue to employ or work with – an individual or entity on...more

Saul Ewing LLP

ALJ Requires MD Anderson Cancer Center to Pay $4.3M for HIPAA Violations

Saul Ewing LLP on

The U.S. Department of Health and Human Services ("HHS"), Office for Civil Rights ("OCR") announced earlier this month that an HHS administrative law judge ("ALJ") ruled in favor of the OCR on summary judgment and required MD...more

Cozen O'Connor

Court Temporarily Enjoins CMS From Withholding Medicare Payments From Home Health Agency

Cozen O'Connor on

A home health agency has scored a second win in its fight to prevent CMS from withholding Medicare payments (to effectuate a recoupment of alleged overpayments), at least for the time being. We previously reported on the...more

Baker Donelson

HHS Expands Settlement Conference Facilitation for Medicare Claims Appeals

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The Department of Health and Human Services (HHS) announced on November 3, 2017 additional settlement options for providers and suppliers in an effort to improve the Medicare claims appeals process, which included (1) the Low...more

Cozen O'Connor

Court of Appeals Finds Jurisdiction In Medicare Appeals Backlog Case

Cozen O'Connor on

The Fifth Circuit has recently held that its courts have jurisdiction to hear a lawsuit seeking to enjoin Medicare from recouping funds until after a hearing because (1) the provider’s claim is collateral to the underlying...more

Mintz - Health Care Viewpoints

Fifth Circuit Decision is Rare Victory Permitting District Court to Enjoin Recoupment Before Provider Exhausts Administrative...

The all-too-common story of a healthcare company declaring bankruptcy in the face of aggressive Medicare recoupment actions before the company even has a hearing before an Administrative Law Judge (ALJ) may get a new ending –...more

McDermott Will & Emery

Medicare Appeals Backlog: A Setback and New Opportunities for Providers

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As of June 2017, the Office of Medicare, Hearing and Appeals (OMHA) had 607,402 appeals pending with a current estimated wait time of three years for an Administrative Law Judge to process a provider’s appeal. At this rate,...more

Baker Donelson

Court of Appeals Reverses D.D.C. Order Requiring HHS to Eliminate Medicare Appeals Backlog by December 31, 2020

Baker Donelson on

Hopes were dashed for sooner relief from the backlog of Administrative Law Judge (ALJ) appeals. With the backlog of Medicare reimbursement appeals steadily growing, a reversal by the U.S. Court of Appeals for the District of...more

BakerHostetler

HHS Ordered To Eliminate Medicare Appeals Backlog By 2021

BakerHostetler on

On January 4, 2017, the U.S. District Court for the District of Columbia rejected a request by the Secretary of HHS asking the court to reconsider its decision that requires HHS to eliminate the backlog of Medicare claims...more

K&L Gates LLP

Health Care Institutions

K&L Gates LLP on

Originally published in Haig, Business and Commercial Litigation in Federal Courts, Fourth Edition §§ 87:1 et seq. © 2016 American Bar Association. This chapter discusses federal court litigation relating to health care...more

Latham & Watkins LLP

Recent Developments in Litigation Challenging the Medicare Appeals Delays: Is Victory Likely for Medicare Providers?

Latham & Watkins LLP on

On September 19, 2016, the U.S. District Court for the District of Columbia (D.D.C.) refused to stay a highly anticipated case seeking to force the government to comply with statutory deadlines governing the Medicare appeals...more

Burr & Forman

Ex-Husband's Revenge Leads to HHS Trophy

Burr & Forman on

Patient care is not confined to a single office or exam room, or a single physician or other provider. Caring for patients these days now includes complex coordination among physicians, nurse, technicians, staff, management,...more

BakerHostetler

ALJ Upholds OCR’s $239,800 CMP for Healthcare Provider

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On January 13, 2016, the Department of Health and Human Services’ Administrative Law Judge upheld the Office for Civil Rights’ (OCR’s) civil monetary penalty (CMP) against Lincare, Inc., d/b/a United Medical (Lincare), for...more

Williams Mullen

Affirming the Need to Fix the Medicare Appeals Backlog: The AFIRM Act of 2015

Williams Mullen on

If you are one of the many health care providers wanting to appeal a Medicare contractor’s reimbursement decision, you may need to be prepared for a long wait. Over the last few years, the backlog of appeals to the...more

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