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PROVIDER ALERT: If You Have Received and Intend to Keep CARES Act Relief Fund Monies, Be Prepared to Open Your Books

If you are a Medicare billing provider, you may have received a portion of the $30 Billion CARES Act Provider Relief Fund monies, with little or no notice or detail. While these monies may have been automatically deposited into your bank account and are considered a grant rather than a loan or payment advance by the government, in order to accept these funds, you must attest to a series of...

A First Look at the CARES Act’s Small Business Administration’s Loan Provisions

On March 25th the U.S. Senate passed the Coronavirus Aid, Relief, and Security "CARES" Act in response to the economic hardships that the COVID-19 pandemic is causing across the country and, today, the House voted to approve the bill. We continue to follow all developments on this and other legal and regulatory changes that impact our clients. While the proposed CARES Act touches upon and modifies a myriad of statutes...

Second Circuit Dicta Concerning FCA “Alternate Remedy” Provision May Create Perverse Incentive for Government to Increase Criminal Prosecution

The Second Circuit's decision in U.S. v. L-3 Communications EOTech, Inc., included ominous dicta pertaining to the "alternate remedy" provision of the False Claims Act (FCA), which may lead to an increase in government determinations to prosecute FCA matters criminally, rather than joining or "intervening" in an ongoing civil suit. The "alternate remedy" provision reads, in pertinent part, that "the Government may elect to pursue its claim [under the FCA]...

SCOTUS Declines to Revisit Third Circuit Decision Containing Expansive Construction of Public Disclosure Bar

On October 7, 2019, the Supreme Court (SCOTUS) denied certiorari in the matter of Pharmerica Corporation v. U.S. ex rel. Silver, leaving on the books the Third Circuit decision which held that the False Claims Act's (FCA) public disclosure bar "is not implicated . . . where a relator's non-public information permits an inference of fraud that could not have been supported by the public disclosures alone[.]" This holding arguably...

Is Your MAO Effectively Capturing and Processing Medicare Advantage Risk Adjustment Data?

Effectively identifying and processing Medicare Advantage (MA) risk adjustment data is no simple matter – it requires extensive experience in data science, claims and encounter data analytics, actuarial science, CMS regulatory and sub-regulatory guidance, and up-to-date, HIPAA-compliant risk adjustment software platforms. Without these skills and technology, valuable MA risk adjustment data that would otherwise be submittable to CMS and generate increased revenues for your organization may be overlooked, ignored or...