American Health Law Association: Institute on Medicare and Medicaid Payment Issues 2023

Partners Scott McBride and Albert Shay will speak during the American Health Law Association’s (AHLA) Institute on Medicare and Medicaid Payment Issues 2023 conference.

Albert Shay will present during the panel “Anything but Basic ‘Basics’: A Deep Dive into Key Concepts of the Physician Self-Referral Law,” on March 23 from 1:15–2:15 pm ET.

Topics will include:

• Using hypothetical scenarios, this advanced-level presentation will provide new insight into some of the “basic” concepts fundamental to the Physician Self-Referral Law
• Connecting the dots between various pieces of governmental guidance, the speakers will explore topics including remuneration, referrals, and “one-off” issues that can prove challenging to ensuring compliance with the Physician Self-Referral Law

Scott McBride will speak during the panel, “What Is an Overpayment Really? Overpayment Investigations, Refunds, and False Claims Act Exposure,” on March 23 from 4:15–5:15 pm ET.

Topics will include:

• The recent Centers for Medicare and Medicaid Services proposed rule abandoning the “reasonable diligence” standard and changing the definition of when a provider is deemed to have “identified” an overpayment under the overpayment statute
• The criteria for identifying Medicare “conditions of payment” capable of triggering overpayments, as distinct from “conditions of participation” and other program rules
• How US Supreme Court decisions in Kisor v. Wilkie and Allina Health Services—and pending cases, SuperValu Inc. and Safeway, Inc.—inform providers’ thinking about potential overpayments
• How federal courts have applied the Escobar “materiality” standard over the past year in the Medicare overpayments and False Claims Act contexts
• Specific overpayment scenarios and case studies