Medicare Audit Provision Immune To Court Review: 3rd Circ.

Law360, New York (February 13, 2014, 6:33 PM EST) -- The Third Circuit on Wednesday ordered a supplier of nursing home services to repay $640,000 in improper reimbursements, issuing a ruling that further walls off the conclusions of Medicare’s private auditors from judicial review.

The decision was the latest to examine a statutory provision that allows auditors who detect a “sustained or high level of payment error” in a small sample of claims to extrapolate and assume that a much larger universe of claims also shouldn’t have been paid.

That provision — added by the Medicare...
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