On December 11, 2024, the Texas Medicaid Agency filed suit against CMS in Federal District Court in Austin to fight an $83 million disallowance of Medicaid payments made to hospital providers in the Austin area between 2014...more
Among the provisions of SECURE 2.0 (effective December 29, 2022) welcomed by plan sponsors were the additions to the Internal Revenue Code that allow qualified plans to refrain from trying to recoup an “inadvertent benefit...more
Several times a year, we get questions from employers involving payroll errors. In some situations, the company or its payroll service double pays an employee for a pay period. In others, the wrong employee receives a direct...more
The Ninth Circuit Bankruptcy Appellate Panel held that the Social Security Administration’s withholding of post-petition benefits to satisfy the debtor’s prepetition obligation to repay overpayments qualifies as recoupment...more
There are two similar but distinct mechanisms through which a creditor might net amounts owed to the debtor against amounts owed by the debtor — setoff and recoupment. Understanding the distinction between them, and how...more
by Lyn Domenick Many retirement plan errors are inadvertent and involve small dollar amounts. However, the work involved in correcting such errors can be time consuming and burdensome. Fortunately, SECURE 2.0 provides that...more
Our firm is seeing an uptick in Medicare demand letters for the recovery of overpayment for skin substitutes, such as WoundFixTM, Biobrane, Dermagraft®, AmnioBand®, or AlloPatch®, used in the treatment of wounds. CMS auditors...more
SECURE 2.0 may cause some insecurity. However, the law’s changes to the treatment of overpayments from employer-sponsored retirement plans may replace that insecurity with relief....more
The United States District Court for the Eastern District of Michigan, applying Michigan law, has held that, even absent an express policy provision regarding recoupment, an insurer was entitled to recoup defense costs after...more
The Consolidated Appropriations Act of 2023, which was signed into law on December 29, 2022, includes numerous provisions impacting retirement savings plans, which are collectively referred to as SECURE 2.0. SECURE 2.0...more
SIU stands for Special Investigation Unit, and nearly all insurance companies have one, especially health insurers. SIUs exist to investigate complaints of fraud, waste or abuse, and train claims personnel to recognize and...more
Applying Delaware Law, the United States District Court for the District of Delaware has held that there is no coverage for acts undertaken by an insured’s directors and officers that occurred prior to the formation of the...more
In situations where there is a dispute over a duty to defend, an insurer may provide a defense to its insured, subject to a reservation of rights, to not only deny coverage for a defense, but also to file a declaratory...more
Perryman v. Stimwave Tech. Inc., C.A. 2020-0079-SG (Del. Ch. Apr. 15, 2021) - Section 145 of DGCL permits corporations to grant advancement rights to persons who may be entitled to indemnification so that they may fund...more
Answering a certified question regarding a matter of first impression, the Nevada Supreme Court has held that an insurer is entitled to reimbursement of defense costs expended in defense of an insured where a determination is...more
JOHN BEAN TECHNOLOGIES CORP. v. MORRIS & ASSOCIATES, INC. Before, Lourie, Reyna, and Wallach. Appeal from the U.S. District Court for the Eastern District of Arkansas - Summary: Recoupment of monetary investment is not...more
As many industries continue to struggle due to the ongoing pandemic, and invoices remain unpaid, it is more important than ever for businesses to understand their setoff and recoupment rights. These rights can be critical to...more
Parties entering into contracts with corporations, limited liability companies, and other legal entities often require proof, in the form of resolutions by the board of directors or members authorizing an identified officer...more
Report on Medicare Compliance 29, no. 7 (February 24, 2020) - Guardian Elder Care Holdings Inc., which operates more than 50 skilled nursing facilities (SNFs) in Pennsylvania, Ohio and West Virginia, and its related...more
After a Medicaid recipient dies, the state must attempt to recoup from his or her estate whatever benefits it paid for the recipient's care. This is called "estate recovery." For most Medicaid recipients, their house is the...more
On July 1, 2015, the SEC issued proposed rules implementing Section 954 of the Dodd-Frank Act, which would obligate national securities exchanges to adopt listing standards that require listed companies to adopt and disclose...more
In the first judgment to provide guidance on the allocation of mesothelioma liabilities at a reinsurance level, the Court of Appeal in Equitas Insurance Limited v Municipal Mutual Insurance Limited [2019] EWCA Civ 718 has...more
Real Property Update - Ad Valorem Taxes: in a matter of first impression, county's immunity from taxation does not extend extraterritorially to property it owns in another Florida county - Joiner v. Pinellas Cnty., Fla.,...more
Real Property Update - Restrictive Covenants: trial court erred by failing to provide injunctive relief in favor of homeowner as it related to trees planted in common area in violation of restrictive covenants - McIntosh...more
With the introduction of RACs, ZPICs, and UPICs, the administrative process for Medicare payment disputes has resulted in three to five year delays in adjudicating claims while providers are faced with almost certain...more