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Healthcare › Health Insurance › Overpayment

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

Baker Donelson

2025 Medicare Physician Fee Schedule: Payment and Overpayment Policies

Baker Donelson on

On December 9, 2024, the Centers for Medicare & Medicaid Services' (CMS's) Calendar Year 2025 Physician Fee Schedule Final Rule (the Final Rule) was published in the Federal Register. The Final Rule includes noteworthy...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

Robinson+Cole Health Law Diagnosis

Two Pathways for Medicaid Self-Disclosures Announced by OMIG

Robinson+Cole Health Law Diagnosis on

The New York Office of the Medicaid Inspector General (OMIG) recently announced updates to its Self-Disclosure Program in response to feedback from Medicaid stakeholders after its revised posting in January 2023. OMIG revised...more

Robinson+Cole Health Law Diagnosis

No More Reasonable Diligence? CMS Proposes to Change Standard for Identifying Medicare Overpayments to Align with False Claims Act

Robinson+Cole Health Law Diagnosis on

On December 27, 2022, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule (Proposed Rule) which proposes certain policy and technical changes to Medicare regulations, including a notable change to the...more

Nelson Mullins Riley & Scarborough LLP

More on Understanding the Medicare Overpayment Appeals Process

Nelson Mullins Riley & Scarborough LLP on

The initial article on this subject discussed generally why Medicare providers need to understand the Medicare administrative appeals process, especially in connection with overpayment determinations, Additional Documentation...more

Nelson Mullins Riley & Scarborough LLP

Understanding the Medicare Overpayment Appeals Process

Nelson Mullins Riley & Scarborough LLP on

Every Medicare provider should understand the Medicare administrative appeals process. Providers are entitled to be reimbursed for their services and want to keep those reimbursements safe from audits. However, if Medicare...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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