CMS Provides MACs, CERT, RACs, and ZPICs with Automatic Denial Authority for “Related claims” Effective March 6, 2014, CMS amended the Medicare Program Integrity Manual giving MACs, RACs, CERT contractors, and ZPICs discretion to automatically …..
For Brintley to prevail on her state-law racial discrimination claim, the appeals court observed that the lack of any direct evidence that St. Mary’s discriminated against her on the basis of her race required Brintley …..
The Centers for Medicare & Medicaid Services (“CMS”) defines hospitals with physician owners or investors as Physician Owned Hospitals. Physician Owned Hospitals utilizing the Stark II whole hospital and rural provider exceptions must now file …..
(“Doughnut Hole”) Medicare Part D Coverage Gap Under the Medicare Part D Prescription Drug Benefit, many Medicare beneficiaries have annually encountered a large gap in their prescription drug coverage that is commonly referred to as …..
It is critically important for hospitals to be especially vigilant about complying with Federal and state fraud and abuse statutes in relation to the Hospital’s financial arrangements with physicians. A jury in a Federal trial …..
A federal district court in Wisconsin recently ruled that a private whistleblower could proceed with her allegations that a physician practice violated the Federal False Claims Act by acting with “reckless disregard” to the existence …..
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