By Daniel Avants, Tiffany Hetland and Amanda Bogle  On June 15, the U.S. Supreme Court ruled in favor of the American Hospital Association and against the Department of Health and Human Services (HHS), holding that the 2018 and 2019 Medicare ...

Tagged with: Medicare

A plaintiff who was owed a medical-malpractice judgment that would partially be reimbursed to Medicare had standing to sue the judgment debtor for delayed payment. However, the 37 days between the judgment and payment did not constitute “delay.” Background In ...

Tagged with: Medicare

Richardson v. PCS Phosphate Co. (Lawyers Weekly No. 004-015-16, 11 pp.) (Graham Mullen, J.) 3:16-cv-00068; W.D.N.C. Holding: Even though state law causes of action relating to a workers’ compensation claim generally are within the exclusive jurisdiction of the North Carolina ...

Tagged with: Medicare

In the largest federal health care fraud settlement ever in North Carolina’s western district, Northcross Medical Center and its former owner, Dr. Mark Tuan Le, agreed on June 9 to pay the United States $6.2 million to settle a lawsuit ...

Tagged with: Medicaid Medicare

Smith v. American National Insurance Co. (Lawyers Weekly No. 14-16-0444, 14 pp.) (Sanford Steelman Jr., J.) Appealed from the Industrial Commission. N.C. App. Unpub. Holding: When plaintiff refused to provide defendants with information concerning a potential Medicare set-aside, the Industrial ...

Tagged with: Medicare

Long-awaited regulations governing the way litigants in personal injury cases with future medical bills should reimburse the government for Medicare payments could come as soon as this year.  But new rules governing Medicare’s secondary payer system could bring more headaches ...

Tagged with: Medicare

CPAs are busy fielding questions on topics ranging from the end of the Bush-era tax cuts to new Medicare taxes for 2013. Changes to the Social Security tax that will raise payments for most of the working population next year are still flying under the radar.

Tagged with: Medicare

Morgan v. Sebelius A physician who obtained hydrocodone samples for his personal use by misleading sales representatives into believing the samples were for patients, and who pleaded guilty to knowingly obtaining a controlled substance by fraud, cannot avoid the ban on participating in the Medicare and Medicaid programs by arguing that the statutory ban under 42 U.S.C. § 1320a-7(a)(3) only applies to “financial misconduct”; the 4th Circuit dismisses the physician’s challenge to application of the ban.

Tagged with: Administrative Medicare

Ojebuoboh v. Sebelius The plaintiff-doctor did not raise the issue of which set of Medicare Guidelines (the 1995 version or the 1997 version) applied until his motion for reconsideration before the Medicare Appeals Council (MAC). Accordingly, the MAC’s adoption of the independent reviewer’s decision to use the 1997 guidelines was not arbitrary, capricious, or an abuse of discretion.

Tagged with: Administrative estoppel Medicare Reimbursement

Almy v. Sebelius The 4th Circuit upholds the Secretary of Health and Human Services’ denial of Medicare Part B coverage for the BIO-1000, a device to treat osteoarthritis of the knee, rejecting the claims of the manufacturer’s bankruptcy trustee that the Secretary improperly used the adjudicative process to develop a policy denying coverage and her decisions were arbitrary and capricious.

Tagged with: Administrative Medicare