South Carolina Lawyers Weekly

Sep 19, 2012

Administrative – Medicare – Convicted Doctor – Hydrocodone Samples – Statutory Ban

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) on[...]

May 2, 2012

Administrative – Medicare – Denial of Coverage – Arthritis Treatment

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 caprici[...]

Sep 23, 2011

Medicare rules on settlements unite litigators in frustration

BOSTON, MA — A looming deadline that will require reporting of personal injury settlements to Medicare has united trial lawyers who are normally adversaries in personal injury cases. Under rules designed to protect Medicare’s lien on medical bills recovered by a personal injury plaintiff, liability insurers must begin collecting data on cases that settle on or after Oct. 1 for reporting to [...]

May 6, 2011

Medicare ACO regulations designed to deliver care efficiently

One of the most eagerly anticipated provisions of the Affordable Care Act is the Medicare accountable care organization (ACO) program, Section 3022 of the Act, which is now known as the Medicare Shared Savings Program. The Centers for Medicare & Medicaid Services (CMS) released long-awaited proposed rules surrounding ACOs on March 31. The proposed rules were published in the Federal Registe[...]