On September 18th, a panel of the Fifth Circuit affirmed a lower court ruling denying injunctive relief against recoupment for Medicare providers still faced with an overpayment demand after going through the first two steps of the administrative review process. In affirming the lower court’s decision, the Fifth Circuit affirmed…
The U.S. Department of Health and Human Services Office of Inspector General (OIG) has recently issued a report regarding overpayment reviews by Medicare Administrative Contractors (MACs). The OIG’s report determined that MACs have been inconsistent in reviewing extrapolated overpayments during the provider appeals process. These inconsistencies have resulted in at…
On August 3, 2020, two issues were approved for review and posted on the Centers for Medicare & Medicaid Services (CMS) Recovery Audit program website: 0184 – Total Hip Arthroplasty: Medical Necessity and Documentation Requirements, and 0185 – Total Knee Arthroplasty: Medical Necessity and Documentation Requirements. In particular, the approved…
The Office of Medicare Hearings and Appeals (OMHA) has recently opened the Settlement Conference Facilitation (SCF) to the appellant community. The SCF is an alternative dispute resolution (ADR) process meant to bring certain providers and the Centers for Medicare & Medicaid Services (CMS) together to discuss mutually agreeable resolutions for…
The Centers for Medicare and Medicaid Services (CMS) has issued two new proposed rules. First, CMS has issued a proposed rule for the 2021 Medicare Physician Fee Schedule (PFS Proposed Rule). The rule will be published on August 17, 2020. You can access the unpublished version here. Second, CMS issued…
On March 24, 2020, the U.S. District Court for the District of Connecticut granted a class of Medicare beneficiaries the right to challenge their designation in hospitals as outpatients receiving observation services rather than as inpatients. In the case, Alexander v. Azar, the court ruled that the Department of Health…
On April 26, 2020, the Centers for Medicare & Medicaid Services (CMS) announced that its suspending its Advance Payment Program to Part B Suppliers, effective immediately. Additionally, CMS announced that it is reevaluating the amounts to be paid out under the Accelerated Payment Program. To date, CMS has paid out…
On April 15, 2020, the Department of Justice announced the following settlement agreements under the False Claims Act (FCA): The U.S. Attorney’s office for the Eastern District of Pennsylvania announced that a laboratory, pain clinic and two former executives agreed to pay $41 million dollars to resolve allegations under the…
The Center for Medicare & Medicaid Services (CMS) has announced that it is increasing payments under Medicare for high-throughput COVID-19 clinical diagnostic laboratory tests. Previously, Medicare Administrative Contractors were paying out $51 for these tests. Under the new payment policy, effective April 14, 2020, Medicare will pay $100 (nearly double…
Today, the U.S. Department of Health and Human Services (“HHS”) announced that it would directly deposit $30 billion in funds into the accounts of providers/suppliers that billed Medicare fee-for-service claims last year. This initial $30 billion is part of a $100 billion appropriation under the CARES Act that HHS will…