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Social services – Medicare – Assignment

Where a plaintiff assignee has filed a complaint against defendant automobile insurers to recover a Medicare beneficiary’s medical expenses under the Medicare Secondary Payer provisions of the Medicare Act, summary judgment should be denied because genuine disputes of material fact remain as to whether the assignor did, in fact, pay any providers for treatments and

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Supreme Court Ruling in AHA v Becerra May Affect 340B Hospitals Reimbursement Rights Against Medicare Advantage Plans | King & Spalding

Hospitals that participate in the 340B program may be entitled to additional monies from Medicare Advantage plans in the wake of the Supreme Court’s decision in AHA v. Becerra. .

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CMS Risk Adjustment Data Validation Final Rule

Centers for Medicare and Medicaid Services released the final rule on risk adjustment data validation audits of Medicare Advantage organizations. There are three key components of the Final Rule and requires MAOs to remit improper payments identified during RADV audits.

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CMS Publishes Final Rule Increasing Government Authority to Recover Overpayments from Medicare Advantage Plans | Troutman Pepper

On February 1, the Centers for Medicare & Medicaid Services (CMS) published a final rule strengthening their authority to recover alleged overpayments made to Medicare Advantage plans..

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District Court Allows Fraud Case Against MAO To Continue

Honorable Skretny of U.S. District Court for the Western District of New York partially granted motion in Teresa Ross v. Independent Health Corporation to dismiss government intervention complaint alleging defendants committed fraudulent risk-adjustment practices.

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