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Administrative Law Judge (ALJ) Health Care Providers Audits

Husch Blackwell LLP

Hospice Insights Podcast - Hospice Audit Updates: Hospices Fare Well in Federal Court

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Increasing audit activity combined with certain decreasingly favorable audit appeal outcomes has resulted in hospices appealing audit results beyond the administrative law judge phase and into federal court. In this episode,...more

Husch Blackwell LLP

Hospice Insights Podcast - Controlling the Narrative: A New Tactic for Auditors and ALJs

Husch Blackwell LLP on

Hospices that have gone through audits are familiar with certain recurring reasons why auditors deny claims. Two common reasons are the lack of support for a six-month prognosis and the insufficiency of the physician...more

Bass, Berry & Sims PLC

Judicial Opinions Support Delay of Recoupment from Audit Appeals Until After ALJ Hearings in Certain Circumstances

Bass, Berry & Sims PLC on

Recent opinions by the Fifth Circuit, the Northern and Southern Districts of Texas, and the District of South Carolina offer hope to providers seeking relief from substantial monetary recoupments during the Medicare appeals...more

Polsinelli

3 Takeaways from the Recent Ruling on Statistical Extrapolations in CMS Audits

Polsinelli on

On Jan. 20, 2016, a federal district court in the Western District of Texas affirmed a decision of the Medical Appeals Council (Appeals Council) affirming a CMS contractor’s extrapolation methodology used to assess an...more

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