News & Analysis as of

Medicare Class Action Centers for Medicare & Medicaid Services (CMS)

American Conference Institute (ACI)

[Virtual Conference] Inaugural Summit on GLP-1 Law & Policy - July 24th, 8:15 am - 5:15 pm ET

The $100B+ Weight-Loss Drug Market Is Red Hot—But So Are the Legal, Regulatory, and Compliance Risks. As the GLP-1 revolution reshapes the future of metabolic health, life sciences companies face mounting scrutiny from...more

Goodwin

Health Headlines - December 2024

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Welcome to the first issue of Health Headlines, a newsletter created by lawyers in our Healthcare practice. In this issue, we cover Medicare Part C oversight, new cybersecurity legislation, healthcare lawsuits and deals, and...more

Benesch

Dialysis & Nephrology Digest - July 2023

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Benesch: NLRB decision overturns use of ‘entrepreneurial opportunity’ super factor for classifying employees - Benesch explains the labor board’s decision retains the 10-point test to determine who can be considered an...more

Benesch

Dialysis & Nephrology Digest - May 2021

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Former CMS administrator Seema Verma joins Monogram Health’s board - Seema Verma was the CEO of health policy firm SVC when she was tapped by the Trump Administration to act as administrator of CMS, a position she held...more

Health Care Compliance Association (HCCA)

Court Says Inpatients Changed to Observation Have Right to Appeal, Orders New Process

Report on Medicare Compliance 29, no. 12 (March 30, 2020) A federal court on March 24 ordered CMS to let Medicare patients “challenge decisions by hospitals” to change their status from inpatients to observation, dating...more

King & Spalding

How Payers Are Improperly Underpaying Inpatient Services As Observation Services

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Health plans and their delegated IPAs are using a number of different tactics to deny payment for inpatient services by improperly classifying inpatient claims as observation or other types of outpatient status. Payers are...more

Sheppard Mullin Richter & Hampton LLP

A (Second) Lawsuit Seeks to Compel Statutory Timeframe for Administrative Law Judge Review of Medicare Claims Appeals

On August 26th, the Center for Medicare Advocacy filed a nationwide class action lawsuit against the Secretary of Health and Human Services. The complaint alleges that, as implemented, the Medicare administrative review...more

King & Spalding

CMS Revises Benefit Policy Manual to Comply with Jimmo Settlement Agreement

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CMS has issued revisions to the Medicare Benefit Policy Manual to comply with the settlement agreement approved in the nationwide class action lawsuit, Jimmo vs. Sebelius. In Jimmo, the plaintiff class alleged that Medicare...more

Cozen O'Connor

Ruminations on Observation

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On July 29, 2013, the Office of Inspector General of the U.S. Department of Health and Human Services (OIG) released a memorandum report finding that Medicare paid more on average for short inpatient stays than for...more

King & Spalding

Proposed Settlement of Medicare Class Action Could Impact Chronic Care Benefits

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On October 16, 2012, representatives of the parties in the nationwide class action lawsuit styled, Glenda Jimmo, et. al vs. Kathleen Sebelius filed a proposed legal settlement with the chief judge of the Federal District...more

Morgan Lewis

Medicare Therapy Coverage Policy to Be Revised

Morgan Lewis on

Proposed class action settlement disavows and discontinues use of the "Improvement Standard." Under a proposed settlement of Jimmo v. Sebelius, No. 5:11-cv-00017 (D. Vt. filed Oct. 16, 2012) filed with the U.S....more

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