Redetermination Appeal Results in Substantial Reduction of Medicare Overpayment

Posted on Firm News November 3, 2017 by Erin Ferber

After submitting a detailed redetermination appeal on behalf of our client’s medical practice, the Firm secured a significant reduction in the overpayment demand – more than a 95% reduction.  In addition to addressing the support for the billed services found in the relevant medical records, the Firm also addressed the statistical sampling methodology used by Read more →

D.C. Circuit Court Reverses Directives to HHS Regarding Appeals Backlog

Posted on Health Care Law News September 16, 2017 by Robert Nicholson

In a 2-1 Decision, the D.C. Circuit Court of Appeals reversed the district court’s order to HHS to clear the backlog of administrative appeals within four years. The appellate court found that the district court failed to adequately test HHS’s assertion that this mandate was impossible. After considering the merits of a group of hospitals Read more →

CMS Announces New Audit Strategy

Posted on Health Care Law News August 16, 2017 by Robert Nicholson

On August 14, 2017, CMS announced a significant change in its claims audit strategy for Medicare Administrative Contractors (MACs).  Under the new strategy — called Targeted Probe and Educate — MACs “will select claims for items/services that pose the greatest financial risk to the Medicare trust fund and/or those that have a high national error rate.”  Read more →

Use of Misbranded Drugs Results in 5 Year Sentence for Oncologist

Posted on Health Care Law News, White Collar News August 8, 2017 by Robert Nicholson

In a recent example of prosecutions of physicians for using adulterated or misbranded drugs and devices, a Tampa area oncologist was sentenced on August 7, 2017 to almost 6 years in prison for using unapproved, foreign-sourced chemotherapy drugs.  According to the Indictment, Dr. Norbergs ordered the drugs from foreign, unlicensed distributors for use in her Read more →

Department of Justice Steps Up Diversion Investigations

Posted on Health Care Law News, White Collar News August 4, 2017 by Robert Nicholson

The Department of Justice has announced the creation of a new Opioid Fraud and Abuse Detection Unit to be comprised of 12 Assistance United States Attorneys in 12 different jurisdictions that will be exclusively assigned to prosecute criminal violations relating to prescription drugs.  The unit reportedly will use data to identify subjects that may be Read more →

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