-
2 months ago | 
natlawreview.com | Matthew Westbrook
The standard for an “identified overpayment” under Medicare Parts A–D now aligns with section 1128J(d)(4)(A) of the Social Security Act, which incorporates by reference the Federal False Claim Act’s (the “FCA”) “knowledge” standard. The previous “reasonable diligence” standard, which, as it related to Part C, had been struck down by a Federal court, no longer applies.
-
Dec 18, 2024 | 
jdsupra.com | Matthew Westbrook
On December 11, 2024, the Office of Inspector General for the U.S. Department of Health and Human Services (“OIG”) issued a special fraud alert warning about certain marketing schemes that involve questionable payments and referrals between Medicare Advantage (“MA”) health plans, health care professionals, and third-party marketers (e.g., agents and brokers) and that can mislead MA enrollees into choosing specific health plans or providers that may not be in the MA enrollees’ best interests...
-
Dec 6, 2024 | 
natlawreview.com | Matthew Westbrook
This week, the U.S. Attorney’s Office for the District of Colorado (“USAO”) announced that it entered into a series of interrelated settlement agreements with companies that provide intraoperative neuromonitoring (“IONM”) services, the companies’ founder, a neurosurgeon, and a businessman affiliated with the companies. IONM services involve the use of electrodes to monitor a patient’s nervous system during surgery.
-
Oct 17, 2024 | 
today.westlaw.com | Matthew Westbrook |Vinay Kohli
Enter to open, tab to navigate, enter to select
-
Oct 16, 2024 | 
mondaq.com | Matthew Westbrook |Vinay Kohli
The health care industry is anxiously awaiting the First
Circuit's ruling on the standard of causation for actions
brought under the False Claims Act (FCA) predicated on a federal
Anti-Kickback Statute (AKS) violation.
-
Oct 11, 2024 | 
jdsupra.com | Vinay Kohli |Matthew Westbrook
The health care industry is anxiously awaiting the First Circuit’s ruling on the standard of causation for actions brought under the False Claims Act (FCA) predicated on a federal Anti-Kickback Statute (AKS) violation.
-
Oct 2, 2024 | 
mondaq.com | Matthew Westbrook |Jonian Rafti |Leslie Shanklin
On August 29, 2024, the Office for Civil Rights of the United
States Department of Health and Human Services
("HHS-OCR") withdrew its appeal of an order by the United
States District Court for the Northern District of Texas'
("District Court") declaring unlawful and vacating a
portion of an HHS-OCR Bulletin, "Use of Online Tracking Technologies by HIPAA
Covered Entities and Business Associates." See Am. Hosp. Ass'n v. Becerra, No. 4:23-cv-1110 (N.D. Tex. June 20, 2024).
-
Sep 30, 2024 | 
jdsupra.com | Jonian Rafti |Leslie Shanklin |Matthew Westbrook
[co-author: Anna Chan]On August 29, 2024, the Office for Civil Rights of the United States Department of Health and Human Services (“HHS-OCR”) withdrew its appeal of an order by the United States District Court for the Northern District of Texas’ (“District Court”) declaring unlawful and vacating a portion of an HHS-OCR Bulletin, “Use of Online Tracking Technologies by HIPAA Covered Entities and Business Associates.” See Am. Hosp. Ass’n v. Becerra, No. 4:23-cv-1110 (N.D. Tex. June 20, 2024).
-
Sep 27, 2024 | 
natlawreview.com | Matthew Westbrook
On August 29, 2024, the Office for Civil Rights of the United States Department of Health and Human Services (“HHS-OCR”) withdrew its appeal of an order by the United States District Court for the Northern District of Texas’ (“District Court”) declaring unlawful and vacating a portion of an HHS-OCR Bulletin, “Use of Online Tracking Technologies by HIPAA Covered Entities and Business Associates.” See Am. Hosp. Ass’n v. Becerra, No. 4:23-cv-1110 (N.D. Tex. June 20, 2024).
-
Aug 7, 2024 | 
mondaq.com | Matthew Westbrook |Whitney Magee Phelps
In the context of Medicare Advantage ("MA") reform initiatives, we previously addressed the Centers for Medicare & Medicaid Services' ("CMS") December 27, 2022 proposal to amend its regulations set forth at 42 C.F.R. § 401.305(a) regarding the standard for an "identified overpayment" under Medicare Parts A–D, to align such regulations with section 1128J(d)(4)(A) of the Social Security Act, which incorporates by reference the "knowledge" standard from the Federal False Claims Act ("FCA") (the...
