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Upcoming Changes Regarding the Use of Statistical Sampling for Overpayment Estimation
  • K&L Gates
  • USA
  • December 5 2018

In a September 28, 2018 Change Request to Medicare’s Program Integrity Manual (“PIM”), the Centers for Medicare & Medicaid Services (“CMS”) updated

CMS Proposes New Telehealth Guidelines and RADV Extrapolation for MAOs
  • McDermott Will & Emery
  • USA
  • November 1 2018

On October 26, 2018, CMS released a Notice of Proposed Rulemaking addressing expanded telehealth coverage in Medicare Advantage, extrapolation of RADV

New Michigan Medicaid OIG Post-Payment Audits Coming
  • Dykema Gossett PLLC
  • USA
  • August 29 2018

On August 15, 2018, the Michigan Department of Health and Human Services (MDHHS) announced the initiation of post-payment claims audits to identify

OMHA to Host Call on Expanded Settlement Conference Facilitation on May 22, 2018
  • K&L Gates
  • USA
  • May 21 2018

The Office of Medicare Hearings and Appeals (“OMHA”) recently expanded the Settlement Conference Facilitation (“SCF”) program, an alternative dispute

Patience is a Virtue, an Administrative Hearing is a Right: Fifth Circuit Creates Possibility of Enjoining Recoupment
  • Breazeale Sachse & Wilson LLP
  • USA
  • May 15 2018

Zone Program Integrity Contractors’ (“ZPIC”) ability to recoup payments as a hospital appeals the ZPIC’s audit finding may have been weakened. A

Inherent Obviousness: Available IPR Rationale With a High Standard
  • Jones Day
  • USA
  • December 8 2017

On November 28, 2017, the PTAB issued a final written decision upholding the patentability of U.S. Patent No. 6,667,061 (IPR2016-01096). The '061

Broker’s Lifetime Ban Twice Called Into Question by D.C. Circuit in Saad v. SEC - Leaving the Standard for Review Uncertain
  • Bressler, Amery & Ross PC
  • USA
  • October 26 2017

The D.C. Circuit Court of Appeals recently remanded a case, for the second time, to the Securities and Exchange Commission ("SEC") to consider whether

OIG Recommends Audits of Meaningful Use Incentive Payments
  • Foster Swift Collins & Smith PC
  • USA
  • August 29 2017

In order to encourage health providers to use electronic medical records (“EHRs”) in lieu of paper records, Congress passed the Medicare and Medicaid

Using Statistical Sampling in False Claims Act Cases
  • Manatt Phelps & Phillips LLP
  • USA
  • August 23 2017

The False Claims Act (FCA) is silent about whether statistical sampling may be used to prove a violation of the Act and, since the case law is varied

New Jersey Department Of Banking And Insurance Proposes To Amend The Rules Implementing HCAPPA
  • Bressler, Amery & Ross PC
  • USA
  • August 23 2017

The New Jersey Department of Banking and Insurance is proposing amendments to the rules which implement the Health Claims Authorization, Processing