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HHS OIG Audit Report on Institutional Status of Medicare + Choice Enrollees

Client Alert | 1 min read | 04.12.03

The HHS Office of Inspector General has released an April 11, 2003 audit report on Medicare + Choice plan institutional status classifications of Medicare + Choice enrollees. Institutional status results in a higher monthly capitation to the plan. The OIG report faults the audited plan for assigning institutional status to patients who were in Medicare certified facilities, but not occupying a bed in a distinct Medicare certified portion of the facility. The OIG audit report rejects Coventry's argument that CMS instructions and the applicable CMS policy letter require only that the beneficiary reside in a certified facility, and not that the bed itself be in beds that the facility has allocated or identified as within a certified portion of the facility. The OIG auditors' position appears contrary to informal guidance previously provided by CMS to health plans. Here is a link to the audit report. http://oig.hhs.gov/oas/reports/region7/70200148.htm

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Client Alert | 3 min read | 07.13.26

Amici Rally Behind Liberty Global, Urging Tenth Circuit to Rein in Economic Substance Doctrine

Following the 10th Circuit's April 21, 2026, decision affirming the disallowance of Liberty Global’s $2.4 billion deduction under the codified economic substance doctrine, I.R.C. § 7701(o), Liberty Global filed a petition for panel rehearing or rehearing en banc on June 5, 2026. That petition has since drawn significant amicus support from various industry groups representing large taxpayers, as discussed below....