News & Analysis as of

Overpayment Enforcement False Claims Act (FCA)

Proskauer - Health Care Law Brief

CMS Publishes Final Rule, Effective January 1, 2025, Addressing the Requirements for Reporting and Returning Overpayments

The standard for an “identified overpayment” under Medicare Parts A–D now aligns with section 1128J(d)(4)(A) of the Social Security Act, which incorporates by reference the Federal False Claim Act’s (the “FCA”) “knowledge”...more

Holland & Knight LLP

Final Medicare Overpayment Rules a Mixed Bag for Providers

Holland & Knight LLP on

The Centers for Medicare & Medicaid Services (CMS) released highly anticipated updates this month to the Medicare regulations interpreting the federal 60-day overpayment refund requirement (the Overpayment Statute). The...more

ArentFox Schiff

Investigations Newsletter: New DC Circuit Ruling Impacts Medicare Advantage Plans and FCA Enforcement

ArentFox Schiff on

In a unanimous opinion, the DC Circuit reversed a successful challenge brought by UnitedHealth (United) and other Medicare Advantage insurers to vacate a Medicare Advantage Overpayment Rule. The Overpayment Rule requires that...more

Wiley Rein LLP

What UnitedHealth’s loss at the D.C. Circuit Means for Medicare Advantage Plans and FCA Enforcement

Wiley Rein LLP on

On Friday, August 13, a D.C. Circuit panel unanimously unwound UnitedHealth Group’s (UnitedHealth) successful challenge to the Medicare Advantage Overpayment Rule, determining that the Centers for Medicare and Medicaid...more

Saul Ewing Arnstein & Lehr LLP

Government demonstrates willingness to enforce Affordable Care Act provision that could cost providers millions of dollars

Under a little-known provision of the Patient Protection and Affordable Care Act (“ACA”), healthcare providers could face millions of dollars in liability for failing to reimburse the government for overpayments in a timely...more

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