R. Ross Burris, III at Polsinelli

DOJ Doubles FCA Civil Penalties

As required by last November's Bipartisan Budget Act of 2015, the Department of Justice on June 30 released an interim final rule making inflationary adjustments to civil monetary penalties under its jurisdiction, including...more

7/8/2016 / Administrative Procedure Act , Bipartisan Budget Act , Civil Monetary Penalty , Department of Justice (DOJ) , Eighth Amendment , False Claims Act (FCA) , Federal Contractors , Health Care Providers , Interim Rule

OMHA Expands Settlement Conference Facilitation Program to Part A Appeals: 10 Things to Know

On Feb. 25, 2016, the Office of Medicare Hearings and Appeals (OMHA) conducted a teleconference to address Phase III of the Settlement Conference Facilitation (SCF) project, which also became effective on Feb. 25, 2016. SCF,...more

3/25/2016 / Administrative Law Judge (ALJ) , Appeals , Centers for Medicare & Medicaid Services (CMS) , Claim Procedures , Health Care Providers , Medicare Part A , OMHA , Settlement Conferences

4 Key Things to Watch on Recent Finding Related to Medicare Appeals Backlog

On Feb. 9, 2016, the D.C. Circuit found that the lower court has the authority to order the Department of Health & Human Services (HHS) to resolve the massive backlog of Medicare appeals tied up in the administrative law...more

3/11/2016 / American Hospital Association , Appeals , Department of Health and Human Services (HHS) , Medicare , Social Security Act , Writ of Mandamus

3 Takeaways from the Recent Ruling on Statistical Extrapolations in CMS Audits

On Jan. 20, 2016, a federal district court in the Western District of Texas affirmed a decision of the Medical Appeals Council (Appeals Council) affirming a CMS contractor’s extrapolation methodology used to assess an...more

2/19/2016 / Administrative Law Judge (ALJ) , Audits , Centers for Medicare & Medicaid Services (CMS) , Extrapolation , Health Care Providers , Overpayment , Summary Judgment

60-Day Overpayment Reporting Final Rule—The Rule of Six

On February 12, 2016, CMS published the Reporting and Returning of Overpayments Final Rule (Final Rule). The Final Rule takes effect on March 14, 2016. Overall, CMS appears to have listened to stakeholders and acknowledged...more

2/16/2016 / 60-Day Rule , Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicare , Medicare Part A , Medicare Part B , Overpayment Recovery Time Limits

CMS Gives Providers Some Leverage in RAC Record Collection Requirements: Five Things to Know about ADRs

The Centers for Medicare & Medicaid Services (“CMS”) announced that it has reduced the maximum percentage of records that providers must submit to Recovery Audit Contractors (“RAC”) through the payment auditing process...more

11/19/2015 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Healthcare , Recovery Audit Contractors (RACs) , Reporting Requirements

Four Key Takeaways on the Expansion of the Medicare Appeals Settlement Conference Project

On October 15, 2015, the Office of Medicare Hearings and Appeals (“OMHA”) conducted a teleconference to address Phase II of the Settlement Conference Facilitation (“SCF”) Pilot, effective October 1, 2015. SCF, launched in...more

10/28/2015 / Administrative Law Judge (ALJ) , Appeals , Centers for Medicare & Medicaid Services (CMS) , Consumer Bankruptcy , Dispute Resolution , Healthcare , Medicare , Medicare Part B , OMHA , Settlement Conferences

New Restrictions: CMS Limits Scope of Review on Redeterminations and Reconsiderations for Certain Audit Appeals

On August 13, 2015, the Centers for Medicare & Medicaid Services (CMS) issued instructions to Medicare Administrative Contractors (MACs) and Qualified Independent Contractors (QICs) regarding the scope of review for...more

9/10/2015 / Centers for Medicare & Medicaid Services (CMS) , Claim Denial Letters , Claim Procedures , Healthcare , MACs , Medicaid , Medicare , QICs , Recovery Audit Contractors (RACs) , ZPIC

Senate Committee Passes Bill Addressing Medicare Appeals Inefficiencies

On June 3, 2015, the Senate Finance Committee passed an original bill that aims to streamline and improve the Medicare Audit and Appeals Process. The Medicare appeals process has recently faced scrutiny from industry leaders...more

6/18/2015 / Administrative Law Judge (ALJ) , Appeals , Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Healthcare , Medicare , OMHA , RAC Audits , Recovery Audit Contractors (RACs) , Senate Finance Committee

R. Ross Burris, III

Polsinelli

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