False Claims Act Insights - Beyond Adversarialism: How to Steer FCA Investigations
Hospice Insights Podcast - Hospice Audit Updates: Hospices Fare Well in Federal Court
Nationwide FLSA Lawsuits Just Got Harder—Here’s Why - #WorkforceWednesday® - Employment Law This Week®
Daily Compliance News: August 1, 2025, The All AI Edition
The Journey of Litigation
Quick Guide to Administrative Hearings
Wire Fraud Litigants Beware: Fourth Circuit Ruling Protects the Banks — The Consumer Finance Podcast
Solicitors General Insights: The Tale of Two Washingtons — Regulatory Oversight Podcast
How confidential is a request to access or challenge information in INTERPOL’s files?
Understanding the Impact of IPR Estoppel and PTAB Discretionary Denials — Patents: Post-Grant Podcast
The Presumption of Innocence Podcast: Episode 64 - Cages We Built: The Making of Mass Incarceration in America
Solicitors General Insights: The Legal Frontlines in Iowa and Indiana — Regulatory Oversight Podcast
(Podcast) The Briefing: The Ninth Circuit Puts the Brakes on Eleanor’s Copyright Claim
The Briefing: The Ninth Circuit Puts the Brakes on Eleanor’s Copyright Claim
(Podcast) The Briefing: No CTRL-ALT-DEL For the Server Test
The Briefing: No CTRL-ALT-DEL For the Server Test
Navigating PTAB’s New Approach to IPR and PGR Discretionary Denial - Patents: Post-Grant Podcast
Solicitors General Insights: A Deep Dive With Mississippi and Tennessee Solicitors General — Regulatory Oversight Podcast
Update on the State of Non-compete Restrictions (LaborSpeak)
UPIC Audits
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
Our firm is seeing an uptick in Medicare demand letters for the recovery of overpayment for skin substitutes, such as WoundFixTM, Biobrane, Dermagraft®, AmnioBand®, or AlloPatch®, used in the treatment of wounds. CMS auditors...more
Report on Medicare Compliance 30, no. 11 (March 22, 2021) - A cancer center has won its appeal of $2 million in Medicare claim denials in a case about modifier 25 and the extrapolation of an overpayment. Problems with the...more
Although newly released data from the Office of Medicare Hearings and Appeals (OMHA) suggests that the Medicare claim appeals backlog might be decreasing, OMHA's case processing time and recent litigation challenging the...more
In a case that could impact health care bankruptcies, where jurisdiction over Medicaid and Medicare claims in bankruptcy are often disputed, the Fifth Circuit, in In re Benjamin v. U.S. Social Sec. Admin., Case No. 18-20185,...more
In a recent decision, the Northern District of Texas, Dallas Division, granted a health care provider a preliminary injunction to prevent the Centers for Medicare & Medicaid Services ("CMS") from withholding Medicare payments...more
HHS’s Office of Medicare Hearings and Appeals (OMHA) has long faced a backlog in Medicare appeals to Administrative Law Judges (ALJs). In an effort to address this backlog, OMHA established a Settlement Conference...more
The Office of Medicare Hearings and Appeals (“OMHA”) recently expanded the Settlement Conference Facilitation (“SCF”) program, an alternative dispute resolution process, to allow more providers and suppliers with pending Part...more
On March 27, 2018, the United States Court of Appeals for the Fifth Circuit published an opinion that provides Family Rehabilitation, Inc. (Family Rehab) a second chance to postpone recoupment of about $7.6 million in...more
A federal appeals court issued a significant ruling last week in relation to the ongoing backlog of Medicare claims appeals. It potentially gives providers a new way to seek relief when Medicare comes to collect money that an...more
A March 27, 2018 decision by the United States Court of Appeals for the Fifth Circuit, Family Rehabilitation Incorporated v. Azar, II, No. 17-11337 (“Family Rehab”), potentially paves the way for Medicare providers to seek...more
On Nov. 3, Health & Human Services (HHS) announced two additional initiatives to address the mounting Medicare appeals backlog at the Administrative Law Judge (ALJ) level: (i) expand the Settlement Conference Facilitation...more
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
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
HHS’s final rule revising procedures for ALJ and Medicare Appeals Council level appeals, announced on January 17, 2017, took effect on March 20, 2017....more
The Department of Health and Human Services (HHS) published its final rule revamping the Medicare appeals process at the Administrative Law Judge (ALJ) level on January 17, 2017. The final rule extensively revises federal...more
For years the hospital industry has been in an uproar over the mountainous backlog of Medicare claim appeals. Current estimates are that a whopping 650,000 claims are at the Administrative Law Judge level awaiting...more
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
On December 5, 2016, a U.S. District Court for the District of Columbia granted summary judgment in American Hospital Association, et al., v. Burwell, in favor of the American Hospital Association (AHA) in its quest to reduce...more
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
Over the past decade, health care providers seeking to challenge Medicare claim denials have faced increasing delays in reaching what many consider the most important step in the Medicare appeals process - a hearing before an...more
HHS announced a Proposed Rule on July 5, 2016 aimed at reducing the backlog of appeals at the Office of Medicare Hearings and Appeals (OMHA) and Departmental Appeals Board (DAB) for Medicare payment and coverage...more
On October 15, 2015, the Office of Medicare Hearings and Appeals (“OMHA”) conducted a teleconference to address Phase II of the Settlement Conference Facilitation (“SCF”) Pilot, effective October 1, 2015. SCF, launched in...more
In keeping with the trend to strengthen its authority to deny an enrollment or revoke Medicare billing privileges, CMS has modified the appeals process in a manner that will significantly shorten the time allotted to mount an...more
For providers who have received inconsistent or varying reasons for denial while navigating through the Medicare appeals process, the Centers for Medicare & Medicaid Services (CMS) has provided much-needed relief in the form...more