August 31, 2017 | Michael Rosenblat

Fixing the ALJ Backlog

In 2014, the American Hospital Association sued the Secretary of Health and Human Services to compel HHS to clear the delay in the Medicare administrative appeals process and to comply with the statutory ninety-day time frame for Administrative Law Judge hearings. (The August 11, 2017, court of appeals opinion can be found here.) Congress directed […]

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July 14, 2017 | Michael Rosenblat

How to Advance your Medicare Appeal after a Reconsideration by a QIC

If you are appealing a reconsideration issued by a Qualified Independent Contractor (QIC) and you have not received a decision within 90 days you may have the right to have your appeal escalated to the next level before the Medicare Appeals Council. An appellant who has properly filed a request for hearing before an Administrative […]

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July 14, 2017 | Michael Rosenblat

Changes to the Medicare Appeals Process

The Centers for Medicare and Medicaid Services (CMS) part of the Department of Health and Human Services (HHS) issued a final rule on January 17, 2017 titled “Medicare Program: Changes to the Medicare Claims and Entitlement, Medicare Advantage Organization Determination, and Medicare Prescription Drug Coverage Determination Appeals Procedures,” (Final Rule), that went into effect March […]

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February 25, 2017 | Michael Rosenblat

False Claims Act case against Lance Armstrong Cycle’s On

Back in 1995, the United States Postal Service (USPS) sponsored the cycling team headed by Lance Armstrong, its top rider. In 2000 Lance Armstrong won the Tour de France and the USPS renewed its sponsorship of the team so long as Armstrong remained part of it. The USPS paid about $32 million to the team […]

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January 27, 2017 | Michael Rosenblat

Medicare Abbreviations

Medicare and its regulation are replete with abbreviations, acronyms, and content specific phrases. The link below contains a list of 75 and growing. I hope you find this list helpful. If you have any additions, please contact me and I will include them. Mike

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November 2, 2016 | Michael Rosenblat

Medicare Audits and Appeals

When Medicare conducts an audit of a provider and concludes that an overpayment has occurred it will attempt to recoup that overpayment.  This article will discuss the overpayment appeals process. There are five levels of appeal, each of which is considered a completely new examination of the audit and determination.  Unlike a judicial appeal in […]

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September 2, 2016 | Michael Rosenblat

Is that Medicare patient Homebound?

One Medicare policy that has seen a boom in litigation, both civil and criminal, in the past few years relates to services being provided to allegedly homebound Medicare beneficiaries.  Homebound status is defined in the Medicare Benefit Policy Manual and states that for a patient to be eligible to receive home health services under Medicare, […]

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August 25, 2016 | Michael Rosenblat

HHS-OIG Issues Alert to Home Health Agencies and Doctors

Chicago – Not surprisingly in light of the recent charges and convictions of home health agencies (HHA) and related entities in the Chicago area and throughout the country, the Department of Health and Human Service, Office of Inspector General, (HHS-OIG) issued an Alert reporting that the OIG found home health services susceptible to fraud. HHAs […]

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June 16, 2016 | Michael Rosenblat

Supreme Court up holds Implied False Certification under the False Claims Act

In a resounding victory for whistleblowers, the Supreme Court, in Universal Health Services, Inc. v. United States et al. ex rel Escobar et al., found that a defendant could be liable for violating the False Claims Act under a theory of implied false certification.  This holding supports the proposition that when a defendant submits a […]

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May 24, 2016 | Michael Rosenblat

Chicago Criminal Defense Lawyer Michael Rosenblat wins fourth not guilty verdict in a row

Chicago Criminal Defense Lawyer Michael Rosenblat wins fourth not guilty verdict in a row. Mr. Rosenblat’s most recent not guilty came on May 13, 2016 when the judge found the defendant not guilty of domestic battery.  The alleged victim claimed that the defendant pushed a heavy object into her knocking her to the ground.  In […]

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