The United States Department of Justice (“DOJ”) reported that it obtained over $4.7 billion in civil settlements and judgments involving federal False Claims Act fraud and abuse claims against the government in 2016. This is the third highest yearly total since the False Claims Act was enacted during the Civil War to help deter fraud […]
On April 17, 2017, the United States Government Accountability Office (GAO) released a report about the current state of Medicaid program integrity. GAO conducted a study of the Medicaid program due to concerns about improper payments and was asked to conduct a study of the Centers for Medicare & Medicaid Services (CMS) to determine the […]
The New York State Office of the Medicaid Inspector General (“OMIG”) has released its annual Work Plan for fiscal year 2017-18. The annual Work Plan offers providers insight into OMIG’s areas of focus in the New York State Medicaid program for the upcoming year. As stated in the Work Plan, the OMIG’s overall mission “is […]
The Centers for Medicare and Medicaid Services (CMS) announced that Performant Recovery, Inc., New York’s Medicare Fee-for-Service Recovery Audit Contractor (RAC) for Region 1, can begin recovery audit activity now that provider outreach is complete. Region 1 includes the following groups of states: J8, WPS: Michigan and Indiana; J15, CGS: Ohio and Kentucky; JK, NGS: New […]
In a decision that is poised to have resonating implications for health services providers, the Supreme Court of the United States explicitly endorsed the “implied false certification theory of liability” under the False Claims Act (FCA) in Universal Health Services, Inc. v. U.S. ex rel. Escobar. Under this theory of liability, any person who submits […]
Last week, we highlighted that the Centers for Medicare and Medicaid Services (“CMS”) released a long-awaited final rule regarding its interpretation of the statutory obligation of Medicare Part A and Part B providers to return any overpayments they receive from the program within 60 days after such an overpayment is “identified.” The final rule is […]
This morning, the Centers for Medicare and Medicaid Services (“CMS”) made available a copy of a final rule clarifying the obligations of providers and suppliers to report and return Medicare overpayments within 60 days after the date on which the overpayment was identified. The final rule will be published in tomorrow’s Federal Register.
Today, the Department of Justice U.S. Attorney’s Office for the Northern District of New York announced a settlement with Medical Reimbursement Systems, Inc. (“MRSI”) to resolve allegations that it violated the false claims act. The press release can be found here. Medical Reimbursement Systems, Inc. provided billing, coding and full revenue cycle services for health care […]
The Centers for Medicare and Medicaid Services (“CMS”) is soliciting topics for new safe harbors and special fraud alerts. The solicitation appeared in the December 23, 2015 Federal Register, and is made each year. Interested commenters have 60 days to submit their proposals. The solicitation may be viewed here.
On August 3, 2015, Judge D.J. Ramos of the Southern District of New York denied Healthfirst’s motion to dismiss the United States’ action under the False Claims Act (FCA) and the related state action. Healthfirst contended in its motion that the government failed to sufficiently plead the case. Notably, in denying this motion, the court […]