Vasilios J. Kalogredis

June 04, 2018 | The Legal Intelligencer

In 2017, insurance company Anthem, Inc. began implementing new medical coverage policies that affect emergency services and medical imaging.

By Vasilios J. Kalogredis

1 minute read

April 30, 2018 | The Legal Intelligencer

On Feb. 16, the U.S. Department of Justice (DOJ) filed a complaint intervening in a qui tam action that two former employees brought against their former employer, Patient Care America (PCA), a compounding pharmacy located in Pompano Beach, Florida, complaint filed by the U.S. Department of Justice, United States Medrano v. Diabetic Care Rx, No. 15-cv-62617 (S.D.FL.). In its complaint, the DOJ alleges unjust enrichment, payment by mistake, and violations of the False Claims Act, 31 U.S.C. Sections 3729-33.

By Vasilios J. Kalogredis

6 minute read

April 05, 2018 | The Legal Intelligencer

The U.S. Department of Justice (DOJ) issued two internal memoranda in January which relate to the agency's role in actions brought under the False Claims Act (FCA) 31 U.S.C. Section 3729.

By Vasilios J. Kalogredis and Katherine E. LaDow

5 minute read

March 01, 2018 | The Legal Intelligencer

On Dec. 19, 2017, a group of New York physicians filed a verified complaint in the U.S. Supreme Court of the state of New York County of Westchester, challenging their partnership's merger with a large hospital practice. The physicians challenging the merger claim that the deal will reduce them to “indentured servants.”

By Vasilios J. Kalogredis and Katherine E. LaDow

6 minute read

January 26, 2018 | The Legal Intelligencer

On Dec. 11, 2017, the U.S. District Court for the District of Columbia held that medical labs do not have to independently verify the medical necessity of tests ordered by physicians and billed to government health care programs such as Medicare and Medicaid. The court issued this ruling in the case Groat v. Boston Heart Diagnostics.

By Vasilios J. Kalogredis

5 minute read

December 04, 2017 | The Legal Intelligencer

On May 1, the U.S. Court of Appeals for the Third Circuit affirmed the dismissal of Petratos v. Genentech, 855 F.3d 481 (3d Cir. 2017) (Petratos), and joined several other circuits in recognizing the heightened False Claims Act (FCA) materiality standard set forth in last year's landmark Supreme Court case, Universal Health Services v. Escobar, 136 S. Ct. 1989, 195 L. Ed. 2d 348 (2016) (Escobar).

By Vasilios J. Kalogredis

14 minute read

November 07, 2017 | The Legal Intelligencer

On Aug. 15, the U.S. Court of Appeals for the Eighth Circuit affirmed the grant of summary judgment by the District Court for the Western District of Arkansas to Johnson Regional Medical Center (JRMC) in its breach of contract suit against its former employee, Dr. Robert Halterman.

By Vasilios J. Kalogredis

10 minute read

October 09, 2017 | The Legal Intelligencer

On July 13, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that includes proposals to update payment policies, payment rates and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after Jan. 1, 2018.

By Vasilios J. Kalogredis

5 minute read

September 01, 2017 | The Legal Intelligencer

On Aug. 15, the Centers for Medicare and Medicaid Services (CMS) proposed changes to the comprehensive care for joint replacement model (CJR), cancellation of a mandatory episode payment models (EPMs) and cardiac ­rehabilitation (CR) incentive payment model. These were previously authorized tests to change reimbursements as to certain cardiac and joint replacement services.

By Vasilios J. Kalogredis

10 minute read

August 08, 2017 | The Legal Intelligencer

On June 20, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would alter the Quality Payment Program (the new Medicare value-based reimbursement system) as required by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). CMS hopes the proposed rule will simplify the Quality Payment Program, especially for small, independent, rural practices, while also ensuring fiscal sustainability and high-quality care within Medicare.

By Vasilios J. Kalogredis

8 minute read