Healthcare Dive

JUNE 22, 2022

The justices declined to take up the case, leaving intact a lower court ruling that backed the 2014 CMS regulation requiring swift return of overpayments.

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Overpayments Overpayment Medicare Medicare 300

Hall Render

JANUARY 12, 2023

On December 27, 2022, the Centers for Medicare & Medicaid Services (“CMS”) published a proposed rule that could potentially have a significant impact on enrollees’ obligations under the “60-day” overpayment rule. In fact, claims reviews to quantify an overpayment is a time-consuming effort and the six-month period is necessary.

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Overpayments Overpayment Medicare Medicare 40

Health Care Law Brief

JUNE 26, 2022

With this denial, the Overpayment Rule remains in full force and effect, and UnitedHealthcare, among other MA plans, must comply or potentially face False Claims Act (FCA) liability. The Overpayment Rule. The Overpayment Rule, set forth at 42 U.S.C. 29844, 29921 (May 23, 2014). See UnitedHealthcare Insurance Co.

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Overpayments Overpayment Medicare Medicare 52

Healthcare Law Today

JANUARY 2, 2023

As written, the proposed rule would remove the existing “reasonable diligence” standard for identification of overpayments, and add the “knowing” and “knowingly” FCA definition. And, a provider is required to refund overpayments it is obliged to refund within 60 days of such identified overpayment.

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Overpayments Overpayment ACA Medicare 52

Healthcare Law Blog

FEBRUARY 1, 2023

Likewise CMS cited its fiduciary duty to protect taxpayer dollars from overpayments and its fiduciary responsibility to recover funds due to the Medicare Trust Funds. case number 18-5326 , which reinstated CMS’s Overpayment Rule for MA organizations. The Court of Appeals reversed and reinstated the Overpayment Rule.

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Medicare Medicare Overpayments Overpayment 105

Health Law Advisor

FEBRUARY 2, 2023

For these years, CMS will limit payment recoveries to “enrollee-level adjustments,” i.e., the non-extrapolated overpayments identified in CMS RADV audits and Department of Health and Human Services Office of Inspector General (OIG) audits. CMS expects to recover a total of $4.7 This total includes $41.1

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Medicare Medicare Overpayments Overpayment 98

Healthcare Compliance Blog

MARCH 16, 2022

It is alleged that between January 2011 and November 2014, the Georgia nursing home submitted claims to Medicare for unreasonable, unnecessary, and unskilled services for rehabilitation therapy. The Georgia nursing home agreed to pay $400,000 to resolve the allegations. This amount was based on the nursing home’s ability to pay.

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Nursing Homes Nurses Overpayments Overpayment 59