In a false-claims settlement for Medicaid overbilling, Virginia’s whistleblower recovery provision entitling relators to a portion of the “proceeds” referred to gross proceeds, not proceeds remaining after the Commonwealth paid appropriate Medicaid refunds to the federal government. Background The relators ...

Tagged with: False Claims Healthcare Justice Stephen R. McCullough Supreme Court of Virginia

A licensed Medicaid provider serving individuals with intellectual disabilities was ordered to repay a state agency for Medicaid reimbursements it issued, due to findings that the provider failed to submit and/or maintain required documentation to support its payment claims. Because ...

Tagged with: Administrative Healthcare Judge Mary B. Malveaux Unpublished Opinion Virginia Court of Appeals

A U.S. Department of Health & Human Services policy for “payment adjustment” calculations by hospitals serving disproportionately needy populations is legislative in nature and should have been promulgated through notice-and-comment rulemaking. Thus, the policy cannot be enforced against a Virginia ...

Tagged with: 4th U.S. Circuit Court of Appeals Administrative Healthcare Judge James A. Wynn Jr.