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Reimbursements › Medicare Advantage Organizations (MAOs)

Davis Wright Tremaine LLP

The Two-Midnight Rule as a Sword but Not a Shield?

Davis Wright Tremaine LLP on

For over a decade, the two-midnight rule has served as an important determinant of whether a hospital inpatient stay is reimbursable by Medicare, as well as a measure of protection for hospitals that treat patients over...more

Arnall Golden Gregory LLP

The Caris MPI Decision: A Potential Turning Point in Out-of-Network Litigation Against Medicare Advantage Organizations

Arnall Golden Gregory LLP on

Nonparticipating providers have often struggled to recover fair reimbursement from vertically integrated, well-resourced Medicare Advantage Organizations (“MAOs”) through out-of-network litigation. The pattern is...more

Mintz - Health Care Viewpoints

CMS Proposed Rule for Refunding Overpayments Would Align With False Claims Act “Knowledge” Standard

Mintz - Health Care Viewpoints on

The Centers for Medicare & Medicaid Services (CMS) proposed a rule late last year to harmonize the standard it would apply for providers to identify and refund overpayments with the “knowledge” standard under the False Claims...more

Epstein Becker & Green

Reimbursement Issues Worth Noting: Administrative Law and False Claims Act Implications

Epstein Becker & Green on

News of two distantly related reimbursement issues with administrative law and False Claims Act (“FCA”) implications is worth noting....more

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