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CMS proposes increased rewards for reporting fraud and abuse

Baker & Hostetler LLP
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USA
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May 2 2013

The Centers for Medicare and Medicaid Services (CMS) recently published a proposed rule modifying certain provisions in their Incentive Reward

OIG updates provider Self-Disclosure Protocol

Baker & Hostetler LLP
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USA
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April 18 2013

On April 17, 2013, the U.S. Department of Health and Human Services Office of Inspector General (OIG) published a revised Provider Self-Disclosure

Sixth Circuit holds physician supervision and enrollment issues are not conditions of payment for purposes of FCA liability

Baker & Hostetler LLP
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USA
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April 18 2013

The Sixth Circuit Court of Appeals recently issued a decision overturning an $11.1 million False Claims Act (FCA) verdict against MedQuest Associates

CMS addresses hospital rebilling after inpatient denials through interim administrator ruling and proposed rule

Baker & Hostetler LLP
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USA
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March 21 2013

On March 18, the Centers for Medicare and Medicaid Services (CMS) published in the Federal Register two important documents addressing the hotly

Federal healthcare fraud enforcement efforts yield a 790 return

Baker & Hostetler LLP
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USA
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February 21 2013

Last week, the U.S. Department of Health and Human Services (HHS) and the DOJ jointly released a report concluding that, for every dollar spent on

Annual report shows meteoric rise in RAC activity

Baker & Hostetler LLP
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USA
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February 21 2013

On February 5, 2013, CMS issued its mandatory Recovery Audit Contractor (RAC or Recovery Auditor) program annual report, detailing overpayments

American Taxpayer Relief Act amends overpayment recovery time limits

Baker & Hostetler LLP
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USA
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January 10 2013

The ATRA significantly alters provider rights related to overpayment recoupment, refunds, audits and claims appeals. A provision entitled "Removing

ALJ appeals frequently favorable to providers; OIG calls for reforms

Baker & Hostetler LLP
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USA
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December 6 2012

The OIG recently published a report reviewing the implementation of 2005 regulations regarding the administrative law judge level of appeals, the third level of the Medicare appeals system

AHA sues HHS for refusal to pay for denied inpatient claims as outpatient services

Baker & Hostetler LLP
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USA
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November 8 2012

On November 1, 2012, the American Hospital Association (AHA) and four healthcare providers brought suit against HHS for maintaining a policy of refusing to pay for medically necessary care provided to patients

House bill proposed to reform Medicare RAC, MAC and ZPIC audits

Baker & Hostetler LLP
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USA
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October 25 2012

The Medicare Audit Improvement Act of 2012, a House bill introduced on October 16, 2012 (Bill), proposes to improve the operations of recovery auditors (RACs), as well as increase transparency and accuracy of audits conducted by other Medicare contractors, including Medicare administrative contractors (MACs), fiscal intermediaries and zone program integrity contractors (ZPICs

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