Affordable Care Act, Overpayment, Healthcare

Affordable Care Act Overpayments in the CY 2025 Medicare Physician Fee Schedule Proposed Rule: Implications for False Claims

Epstein Becker & Green on 8/13/2024

Stakeholders are continuing to analyze the implications of the mammoth proposed rule on “Medicare and Medicaid Programs: [Calendar Year (CY)] 2025 Payment Policies under the Physician Fee Schedule and Other Changes to Part B...more

Health Law Pulse - September 2016

Robinson & Cole LLP on 9/7/2016

DOJ, NY AG REACH SETTLEMENT WITH HOSPITALS IN LANDMARK 60 - DAY RULE CASE - On August 24, 2016, the U.S. attorney for the Southern District of New York and the New York State attorney general announced a $2.95 million...more

Program Integrity Changes to the Medicare Provider Enrollment Process

McDermott Will & Emery on 3/11/2016

On March 1, 2016, the U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services (CMS) published a proposed rule (Proposed Rule) entitled “Medicare, Medicaid, and Children’s Health Insurance...more

Skeletons in the Closet? Beware of Potential Enforcement Actions

Mintz - Health Care Viewpoints on 10/29/2015

With Halloween looming, a discussion of skeletons that may be lurking in a health care provider’s closet is timely. Many of our previous posts, as well as the monthly Qui Tam Updates published by our Health Care Enforcement...more

OMB Receives Final Medicare Parts A and B 60-Day Overpayment Rule from CMS

King & Spalding on 10/28/2015

On October 21, 2015, the Office of Management and Budget (OMB) received the Medicare Parts A and B overpayment final rule from CMS which is the last phase before the rule is issued in the Federal Register. While the text of...more

Recent Cases Involving 60-Day Overpayment Rule Should Put Healthcare Providers on Alert

Lowndes on 10/1/2015

Two recent federal court cases show that the federal government intends to vigorously enforce the so-called “60-day Rule” for the return of overpayments enacted as part of the Affordable Care Act (the “ACA”) even though the...more

The 60 Day Rule — Identification and Knowing Avoidance

Ballard Spahr LLP on 8/26/2015

On August 3, 2015, the United States District Court for the Southern District of New York issued an opinion and order in Kane v. Healthfirst, Inc., et al.[1] that provides the first judicial interpretation of the requirement...more

Federal Court Rejects Health System's Efforts to Dismiss 60-Day Rule Suit

Robinson & Cole LLP on 8/21/2015

On August 3, 2015, the United States District Court in the Southern District of New York issued a long-awaited opinion and order rejecting a motion to dismiss filed by the defendants in U.S. ex rel. Kane v. Continuum Health...more

Court Imposes Potentially Unworkable Burden on Providers Under ACA's Report and Return Rule

Baker Donelson on 8/20/2015

In Kane ex rel. U.S. v. Healthfirst, Inc., the federal district court for the Southern District of New York (District Court or Court) provided on August 3 the first and long-awaited interpretation as to when a health care...more

Kane and the “60-Day Rule”: The Unforgiving World of Medicare and Medicaid Overpayments

BakerHostetler on 8/14/2015

The Southern District of New York has spoken on one of the first issues to confront those seeking compliance with the new “60-day rule” under the Affordable Care Act (ACA), and it does not bode well for defendant hospitals...more

FCA 60-Day Repayment Provision Runs from Discovery of Potential Overpayment

Holland & Knight LLP on 8/12/2015

The U.S. District Court for the Southern District of New York issued the first decision directly addressing when an overpayment is “identified” for purposes of starting the 60-day repayment clock under the federal False...more

The Clock’s Running Fast: SDNY Is First to Interpret “Identification” Under the FCA’s “60-Day Rule” for Government Overpayments

Epstein Becker & Green on 8/11/2015

On August 3, 2015, in United States ex rel. Kane v. Healthfirst, Inc., et al., No. 1:11-cv-02325 (S.D.N.Y. Aug. 3, 2015), the United States District Court for the Southern District of New York issued the first reported...more

In Closely Watched Case, Federal Court Upholds the Government’s Position on Provider Mandate to Report and Return Medicare and...

Cadwalader, Wickersham & Taft LLP on 8/7/2015

The Patient Protection and Affordable Care Act (“PPACA”), signed into law on March 23, 2010, included a provision (the “Report and Refund Mandate”), broadly requiring health care providers, suppliers, Part D plans and managed...more

First Court Opinion on When an Overpayment is “Identified” for Purposes of the 60-Day Repayment Law

Morgan Lewis on 8/6/2015

The court’s interpretation complicates the already difficult task providers face in having sufficient time to assess and quantify potential overpayments. An August 3 decision in United States v. Continuum Health Partners...more

SDNY Issues Groundbreaking Decision On False Claims Act Sixty-Day Rule

Polsinelli on 8/6/2015

Medicare and Medicaid providers have an obligation to refund overpayments from federal health care programs. The False Claims Act (“FCA”) imposes liability for any person who “knowingly conceals or knowingly and improperly...more

Kane v. Healthfirst and the 60-day Repayment Rule

Carlton Fields on 8/6/2015

Case: Kane v.Healthfirst, Inc. et al. and U.S. v. Continuum Health Partners Inc. et al., case number1:11-cv-02325, in the U.S. District Court for the Southern District of New York. As part of the Affordable Care Act...more

Government demonstrates willingness to enforce Affordable Care Act provision that could cost providers millions of dollars

Saul Ewing Arnstein & Lehr LLP on 11/5/2014

Under a little-known provision of the Patient Protection and Affordable Care Act (“ACA”), healthcare providers could face millions of dollars in liability for failing to reimburse the government for overpayments in a timely...more

Patient Protection and Affordable Care Act (PPACA) › Overpayment › Healthcare