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Tag Archives: Healthcare

SCV: Whistleblowers entitled to portion of gross settlement (access required)

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 ...

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CAV: $1 million Medicaid repayment order upheld (access required)

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 ...

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4th Cir.: Medicaid payment-adjustment policy invalid (access required)

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 ...

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