News & Analysis as of

Health Insurance › Overpayment › Patient Protection and Affordable Care Act (PPACA)

Fishman Haygood LLP

U.S. Fifth Circuit Adopts “Class Certification” Approach to Article III Standing at Certification Stage

Fishman Haygood LLP on

The U.S. Fifth Circuit Court of Appeals recently reversed a Texas district court’s denial of class certification in the case of Wilson v. Centene Management. In the litigation, three Texans filed suit against Centene...more

Ropes & Gray LLP

CMS Issues Final Rules for Medicare Parts A and B Overpayments: Key and Lingering Questions

Ropes & Gray LLP on

In November 2024, the Centers for Medicare & Medicaid Services (“CMS”) released a final rule addressing, among other things, the Medicare Parts A and B overpayment provisions of the Affordable Care Act (the “Final Rule”). It...more

Epstein Becker & Green

Affordable Care Act Overpayments in the CY 2025 Medicare Physician Fee Schedule Proposed Rule: Implications for False Claims

Epstein Becker & Green on

Stakeholders are continuing to analyze the implications of the mammoth proposed rule on “Medicare and Medicaid Programs: [Calendar Year (CY)] 2025 Payment Policies under the Physician Fee Schedule and Other Changes to Part B...more

Alston & Bird

CMS Reverses Course on Medicare Overpayment Rule

Alston & Bird on

The Centers for Medicare & Medicaid Services has proposed to redefine what it means to “identify” a Medicare overpayment. The proposal would remove the requirement that providers, suppliers, managed care organizations, and...more

Spilman Thomas & Battle, PLLC

The Rise of Managed Care Audits and Reimbursement Demands in the Wake of the ACA

Spilman Thomas & Battle, PLLC on

If the summer of 2017 demonstrated anything, it is that health care remains a complex and contentious industry. One of its many complications stems from the natural tension between health care providers and health care...more

King & Spalding

D.C. District Court Allows Part C Plan to Continue with Challenge of Overpayment Rule

King & Spalding on

On March 31, 2017, Judge Rosemary Collyer of the United States District Court for the District of Columbia held that plaintiffs UnitedHealthcare Insurance Company et al. (“United”) had standing to challenge CMS’s overpayment...more

Alston & Bird

A&B Healthcare Week in Review

Alston & Bird on

I. REGULATIONS, NOTICES, & GUIDANCE - On April 15, 2016, the Food and Drug Administration (FDA) issued a proposed rule entitled, “Applications for Approval and Combinations of Active Ingredients Under Consideration for...more

Carlton Fields

Kane v. Healthfirst and the 60-day Repayment Rule

Carlton Fields on

Case: Kane v.Healthfirst, Inc. et al. and U.S. v. Continuum Health Partners Inc. et al., case number1:11-cv-02325, in the U.S. District Court for the Southern District of New York. As part of the Affordable Care Act...more

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