Medicare and Medicaid Payment Issues Conference

Healthcare Regulatory & Enforcement attorneys Melissa Wong and Susan Banks will be speaking at the AHLA Institute on Medicare and Medicaid Payment Issues Conference. This three-day event will cover an array of legal and regulatory topics crucial for navigating the complexities of reimbursement. Attendees will gain insights into the implementation of these policies and how they affect the advisement of clients within the healthcare sector.

Ms. Wong will be discussing the shifting patterns observed in Medicare Advantage (MA) enrollment as they relate to the decrease in traditional fee-for-service (FFS) Medicare. She will explore the potential disparities in hospital payments for services rendered to FFS and MA enrollees and how MA data in the hospital cost report can affect critical reimbursement factors. Additionally, she will provide insights into the contracting terminology necessary for determining payment outcomes and final reimbursement settlements, as well as current and anticipated litigation trends concerning MA's influence on hospital cost report payment matters.

Ms. Banks will be discussing the layered statutes and guidelines that dictate Medicare payments, specifically focusing on the federal Overpayments Statute and related obligations for providers to return overpayments. Her presentation will highlight significant court rulings that define Medicare's payment rules, the distinctions between "conditions of payment" and "conditions of participation," and how these affect the identification of overpayments. She will also touch on courts' application of the Escobar "materiality" standard and offer practical strategies for resolving overpayment issues, underpinned by recent case law developments and real-world examples.

Session Times and Topics

Medicare Advantage or Disadvantage? A Hospital Reimbursement Perspective (Advanced)
Melissa Wong, Speaker
March 21, 2024 | 4:00 – 5:00 p.m. ET
March 22, 2024 | 9:15 – 10:30 a.m. ET 

What Is an Overpayment Really? Overpayment Investigations, Refunds, and False Claims Act Exposure (Advanced)
Susan Banks, Speaker
March 21, 2024 | 9:15 – 10:30 a.m. ET
March 22, 2024 | 9:15 – 10:30 a.m. ET