60-Day Overpayment Rule Released

Posted on February 11, 2016 in Legal Updates, Retained Overpayments, Reverse False Claims, Statutes and Regulations

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CMS has released its final 60-Day Overpayment Rule, providing clarity to the 2010 Affordable Care Act (“ACA”) amendment to the False Claims Act (“FCA”) that created FCA liability for failure to repay identified overpayment within 60 days. This is a long-awaited rule that provides essential clarity to an amendment that,... Continue Reading →

Tags: CMS, False Claims, False Claims Act, FCA, Retained Overpayments, rule

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The FCA, Advice of Counsel Defense and CMS Commentary Meets the Jury

Posted on July 7, 2015 in Case Analysis, Legal Updates, Litigation Handbook, Privilege, Stark Act, Statutes and Regulations

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A recent court decision had highlighted two issues on the cutting edge of health care and False Claims Act (“FCA”) law. Both address what happens in the transition from health care advice to health care litigation. The first is the application of the attorney client privilege and the advice of counsel... Continue Reading →

Tags: Advice of Counsel, CMS, commentary, False Claims Act, FCA, jury, Stark

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Up the Creek Without a Regulation

Posted on February 16, 2015 in Litigation Handbook, Reverse False Claims, Statutes and Regulations

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by David B. Honig and Brian C. Betner CMS Announces Further Delay of Repayment Rule To be published in the February 17, 2015 Federal Register, CMS has extended its deadline for finalizing the Affordable Care Act’s (“ACA”) 60-day payback rule. This is the rule that requires a Medicare or Medicaid provider to return... Continue Reading →

Tags: CMS, False Claims Act, regulation, retained overpayment, Reverse False Claims

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CMS Publishes Administrative Ruling and Proposed Rule Providing Additional Part B Payment to Hospitals Denied Inpatient Payment

Posted on March 18, 2013 in Statutes and Regulations

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Executive Summary On March 13, 2013, CMS concurrently released an immediately effective administrative ruling (“CMS Ruling 1455-R” or “Ruling”) and a proposed rule (“Proposed Rule”) reversing CMS policy precluding hospitals from billing on an outpatient basis for inpatient services denied payment on grounds the services should have been provided on... Continue Reading →

Tags: CMS, denied, False Claims Act, inpatient, Medciare, outpatient, rebill, rule

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A Twenty Year Statute of Limitations?

Posted on March 15, 2012 in Statutes and Regulations

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Last month the Centers for Medicare & Medicaid Services (CMS) published proposed rules for reporting of overpayments. These proposed rules, if adopted and strictly interpreted, could effectively create a twenty-year statute of limitations under the False Claims Act.... Continue Reading →

Tags: 60 day, Centers for Medicare and Medicaid Services, CFR, CMS, CMS–6037–P, Code of Federal Regulations, False Claims Act, FCA, identification, overpayment, proposed rule, regulation, sixty day, statute of limitations, ten years

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