News & Analysis as of

Reimbursements Appeals Centers for Medicare & Medicaid Services (CMS)

Epstein Becker & Green

A Common Denominator Governs the Medicare Fraction - SCOTUS Today

Epstein Becker & Green on

In its 2022 decision in Becerra v. Empire Health Foundation, for Valley Hospital Medical Center, the U.S. Supreme Court held that the phrase “entitled to [Medicare Part A] benefits” applied to “all those qualifying for the...more

McDermott Will & Emery

CMS Poised for Medicare, Medicaid Integrity Enforcement Actions

McDermott Will & Emery on

The Trump administration and 119th Congress are preparing to reduce federal expenditures by targeting Medicare and Medicaid fraud, waste, and abuse. Medicare enrollment revocations, Medicaid enrollment terminations, and...more

King & Spalding

CMS Reworks the Medicare Cost Report for Hospitals

King & Spalding on

On December 29, 2022, CMS posted on its website Transmittal 18, which implements sweeping changes to the Medicare cost report for hospitals and its accompanying instructions. The revisions affect nearly every facet of...more

King & Spalding

D.C. Circuit Rejects Critical Access Hospital’s Appeal for Medicare Payments to On-Call Specialty Physicians

King & Spalding on

On April 15, 2022, the D.C. Circuit affirmed the denial of a California hospital’s request to obtain critical access hospital cost reimbursement from Medicare for the costs incurred to keep non-emergency specialty physicians...more

Arnall Golden Gregory LLP

Is There a Constitutional Limit to Excessive Fines in False Claims Act Cases? Eleventh Circuit Says a Million Dollar Fine for a...

In late December, the U.S. Circuit Court of Appeals for the Eleventh Circuit issued its decision in Yates v. Pinellas Hematology & Oncology, P.A. The appellate court affirmed the district court’s imposition of damages and...more

King & Spalding

Court of Appeals Upholds CMS Rule Requiring Public Disclosure of Prices Negotiated Between Hospitals and Insurance Companies

King & Spalding on

On December 29, 2020, the U.S. Court of Appeals for the District of Columbia Circuit upheld a CMS final rule promulgated in November 2019 that requires hospitals to disclose various forms of pricing information related to the...more

Holland & Knight LLP

Second Circuit Paves Easier Route to Prosecute Disclosure of Agency Information, Insider Trading

Holland & Knight LLP on

In a ruling with far-reaching implications, the U.S. Court of Appeals for the Second Circuit recently held that pre-announcement information at the Centers for Medicare & Medicaid Services (CMS) about reimbursement rates...more

K&L Gates LLP

K&L Gates Triage: Recent Developments Impacting Drug Pricing and the 340B Program: Part 2

K&L Gates LLP on

In Part Two of this two-part series on recent developments in pharmacy law and the 340B drug pricing program, Richard Church and Ryan Severson discuss several recent developments related to the 340B drug pricing program,...more

King & Spalding

Eighth Circuit Upholds CMS’s Methodology for Calculating the Volume Decrease Adjustment for Cost Reporting Periods Preceding...

King & Spalding on

Last week, the United States Court of Appeals for the Eighth Circuit issued a consolidated opinion for three cases in which it upheld the methodology that CMS used to calculate the volume decrease adjustment (VDA) for...more

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