News & Analysis as of

Healthcare Fraud Medicare Billing

K&L Gates LLP

Urinary Catheter Fraud Sparks Proposed Medicare Payment Changes for ACOs

K&L Gates LLP on

Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program got good news from The Centers for Medicare and Medicaid Services (CMS) related to widespread fraud involving urinary catheters that...more

Bass, Berry & Sims PLC

While Remote Supervision Remains Available for Direct Supervision, Be Mindful of the Other “Incident to” Requirements

Bass, Berry & Sims PLC on

With the May 11, 2023 expiration of the federal public health emergency (PHE) for COVID-19, many operational flexibilities healthcare providers used during the PHE will now sunset. Some flexibilities end immediately while...more

Epstein Becker & Green

Telemental Health Laws: Overview - 2022

Epstein Becker & Green on

Since 2016, Epstein Becker Green (EBG) has researched, compiled, and analyzed state-specific content relating to the regulatory requirements for professional mental/behavioral health practitioners and stakeholders seeking to...more

Oberheiden P.C.

Medicare TPE Audits: 6 Things You Need to Know

Oberheiden P.C. on

Targeted Probe and Educate (TPE) audits have recently become a common tool used by both law enforcement and private insurers in the Medicare program. While they focus on educating Medicare providers about proper billing...more

Oberheiden P.C.

Federal Government Targets Providers Administering Amniotic Injections

Oberheiden P.C. on

The federal government has recently made clear its intention to go after healthcare providers who provide amniotic injections to certain Medicare and Medicaid recipients. Over recent years, the federal government has...more

Oberheiden P.C.

CMS and DOJ are Scrutinizing Medicare Billings for Amniotic Injections

Oberheiden P.C. on

The Centers for Medicare and Medicaid Services (CMS) and U.S. Department of Justice (DOJ) are scrutinizing health care providers’ Medicare billings for amniotic injections. These injections are only eligible for Medicare...more

Akin Gump Strauss Hauer & Feld LLP

11th Circuit’s Decision in AseraCare: Important in Determining When Clinical Judgment Regarding Medical Necessity Can Result in an...

• Reasonable disagreement among clinicians, by itself, does not result in a false claim. • Clinical judgment must be objectively false to constitute an FCA violation. • A clinical judgment may only be objectively false...more

Dorsey & Whitney LLP

Relator Failed to Sufficiently Plead its FCA Action by Relying on Big Data Alone, Resulting In Big Dismissal

Dorsey & Whitney LLP on

In early August, the U.S. District Court for the Western District of Texas granted a hospital system’s motion to dismiss a False Claims Act case that illustrates the increasing intersections in FCA litigation between data...more

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