On January 14, the Department of Justice (DOJ) announced that five Kaiser Permanente affiliates agreed to pay $556 million to resolve allegations that they violated the False Claims Act (FCA) by submitting unsupported diagnosis codes for Medicare Advantage (MA) beneficiaries to increase reimbursement from the federal government. The relators will receive approximately $95 million as their share of the recovery.Continue Reading Kaiser Permanente Affiliates Settle Medicare Risk Adjustment Fraud Case for $556 Million
Brian Roark
Brian Roark is co-chair of the Bass, Berry & Sims Healthcare Fraud Task Force and concentrates his practice on representing healthcare clients in responding to governmental investigations and defending False Claims Act lawsuits. He has successfully litigated and resolved numerous healthcare fraud matters involving hospitals and health systems, ambulatory surgery centers, hospices, home health companies, drug and alcohol abuse treatment centers, Medicare Advantage companies, and other healthcare providers.
Potential Shift in Healthcare Fraud Oversight
I recently provided insight about the potential shift in healthcare fraud oversight amid federal changes and several recent cases that could narrow the scope of investigations and ultimately lower costs that health systems spend to fight fraud allegations.Continue Reading Potential Shift in Healthcare Fraud Oversight
First Circuit Adopts “But-For” Causation Standard for Proving Kickback FCA Violations
In a closely watched appeal, the U.S. Court of Appeals for the First Circuit ruled on February 18 that to satisfy the causation requirement in False Claims Act (FCA) actions based on alleged Anti-Kickback Statute (AKS) violations, the government or relator must prove that the alleged kickbacks were the “but-for” cause of the defendant’s allegedly false claims. The First Circuit joins the Sixth and Eighth Circuits in adopting this defendant-favorable standard, with only the Third Circuit requiring a less-stringent showing.Continue Reading First Circuit Adopts “But-For” Causation Standard for Proving Kickback FCA Violations
Register Now: The Supreme Court and the False Claims Act Webinar Replay
The Supreme Court recently released important opinions that will shape False Claims Act investigations and litigation for years to come. Continue Reading Register Now: The Supreme Court and the False Claims Act Webinar Replay
Register Now: The Supreme Court and the False Claims Act Webinar

Please join us on Thursday, July 13 at 12pm CT as we examine how False Claims Act cases ended up before the Supreme Court, the Court’s analysis of these cases, and the lasting impact that these opinions will have for those dealing with False Claims Act-related issues. Continue Reading Register Now: The Supreme Court and the False Claims Act Webinar
Bass, Berry & Sims Notches Wins for Clients in Trio of False Claims Act Qui Tam Lawsuits
Bass Berry & Sims recently secured dismissals on behalf of healthcare providers in three separate False Claims Act (FCA) qui tam lawsuits in a matter of a week’s time. Continue Reading Bass, Berry & Sims Notches Wins for Clients in Trio of False Claims Act Qui Tam Lawsuits
Sixth Circuit Reins In Anti-Kickback Statute
On March 28, the Sixth Circuit issued an important decision on the meanings of “remuneration” and “causation” under the Anti-Kickback Statute (AKS), holding that remuneration “covers just payments and other transfers of value” and not “any act that may be valuable to another,” and that to establish False Claims Act (FCA) liability based on AKS violations, a relator or the government must prove a causal link between the alleged kickback scheme and the alleged false claim. Continue Reading Sixth Circuit Reins In Anti-Kickback Statute
False Claims Act Cases in Home Health Sector
I recently discussed the trends related to False Claims Act (FCA) settlements in the home health sector, as revealed in the Healthcare Fraud & Abuse Settlements Database which we launched earlier this year. The database was part of the comprehensive Healthcare Fraud & Abuse Resource Center that provides an overview of FCA enforcement settlements, court decisions, updates involving the Stark Law and Anti-Kickback Statute, and other developments affecting the healthcare industry.
“We wanted to create a database of False Claims Act settlements to allow providers to have easy access to information, to see the cases that the government or regulators have resolved in the health care fraud space,” I told Home Health Care News. “This is the first publicly available database of this type.”
According to the information in the database, home health providers have paid at least $422.6 million since 2012 to settle FCA allegations. This represents 51 different cases over the time period from 2012-2020.Continue Reading False Claims Act Cases in Home Health Sector
Impact of Supreme Court’s Escobar Decision on Fifth Anniversary
We explored the impact of the Supreme Court’s decision in Universal Health Servs., Inc. v. U.S. ex rel. Escobar to mark the fifth anniversary of this key False Claims Act opinion in a recent article for Law360. As we point out in the article, the Supreme Court’s decision “continues to have a profound impact on…
Download and Register Now – Healthcare Fraud & Abuse Review and Webinar from Bass, Berry & Sims
Bass, Berry & Sims is pleased to announce the release of the newest edition of its Healthcare Fraud & Abuse Annual Review examining important healthcare fraud developments in 2020. Compiled by the firm’s Healthcare Fraud Task Force, the Review provides an in-depth and comprehensive analysis of the past year’s court decisions involving the False…