We contributed to the Fraud and Abuse Chapter of the Health Law Handbook, 2024-2025 Edition. In the portion of our content, titled “Healthcare Fraud and Abuse Update,” we outlined regulatory developments, key court decisions and noteworthy settlements related to the Anti-Kickback Statute and Stark Law. Continue Reading Fraud and Abuse Chapter of Health Law Handbook, 2024-2025 Edition
False Claims Act Settlements to Know from Q3 2024
The third quarter of this year brought numerous high-dollar False Claims Act (FCA) settlements involving a variety of industries and alleged conduct.Continue Reading False Claims Act Settlements to Know from Q3 2024
FCA Risk for Private Equity Investment in Healthcare for Mergers & Acquisitions Magazine
We contributed an article addressing the mounting risks faced by private equity (PE) firms investing in the healthcare industry in the July/August 2023 issue of Mergers & Acquisitions Magazine. In the article, we delved into the complexities of this highly-regulated sector and the heightened attention it receives from government enforcement bodies. Continue Reading FCA Risk for Private Equity Investment in Healthcare for Mergers & Acquisitions Magazine
Register Now | How to Respond to a Civil Investigative Demand Webinar
Join us on September 13 for a webinar in which we will discuss responding to a government investigation and specifically responding to a CID.Continue Reading Register Now | How to Respond to a Civil Investigative Demand Webinar
Increased False Claims Act Exposure for Private Equity Firms Investing in Healthcare
I recently authored an article for the American Bar Association (ABA) Health Law Section detailing the growing need for private equity firms to consider the increased risk of False Claims Act (FCA) liability.
Continue Reading Increased False Claims Act Exposure for Private Equity Firms Investing in Healthcare
Tennessee Healthcare Fraud and Abuse Laws
I recently outlined healthcare-related fraud and abuse laws in Tennessee as part of Thomson Reuters’ Practical Law survey. My content focused on Tennessee is part of a series that examines state-by-state laws and regulations addressing civil and criminal actions, consequences for violation, and Medicaid program integrity provisions.
Continue Reading Tennessee Healthcare Fraud and Abuse Laws
Telehealth Scrutiny Following COVID-19 Pandemic
During the COVID-19 pandemic, many healthcare providers have relied on telehealth options to provide patients access to care. But, as I discussed in a recent article for Physicians Practice, “As long as utilization of telehealth services remains high, corresponding scrutiny and government enforcement efforts will remain focused on this area.”
In the article, I recommend ways that physicians and other providers can prepare for this additional scrutiny:Continue Reading Telehealth Scrutiny Following COVID-19 Pandemic
Eighth Circuit Affirms Dismissal of Kickback Case
On June 25, the U.S. Court of Appeals for the Eighth Circuit affirmed the dismissal with prejudice of a qui tam False Claims Act (FCA) suit alleging certain physician compensation arrangements at Trinity Health violated the Anti-Kickback Statute (AKS) and Stark Law.
The relator, a former surgeon at one of Trinity’s hospitals, alleged the following:
- Trinity paid five of its highest-earning physicians above fair market value by compensating them in excess of 90th percentile compensation for their specialties at levels not justified by their personal productivity.
- The high compensation generated practice losses for Trinity absent taking into account the physicians’ downstream referrals to the health system.
- As a result of the physicians’ compensation methodology, they performed unnecessary surgeries to inflate their compensation.
- Trinity opted not to renew the relator’s contract because he complained about these allegedly-unnecessary surgeries.
Continue Reading Eighth Circuit Affirms Dismissal of Kickback Case
Qui Tam Complaint Against Pharmacy Dismissed for Lack of Particularity
On May 6, the U.S. District Court for the District of South Carolina entered final judgment dismissing with prejudice a relator’s qui tam False Claims Act (FCA) suit against the defendant wholesale pharmacy. The relator, a former pharmacist who worked for the defendant, alleged that the defendant submitted false claims to government healthcare programs in connection with prescription medications dispensed for use at nursing homes and assisted living facilities. The relator alleged a scheme in which the defendant manually filled “thousands” of prescriptions with less-expensive generic medications while billing for more-expensive alternative medications stocked in its automated dispensing system.
A qui tam complaint containing similar allegations filed against Omnicare Inc. in the U.S. District Court for the District of New Jersey resulted in an $8 million settlement in 2017. In this lawsuit, however, the defendant, represented by Bass, Berry & Sims and others, obtained full dismissal with prejudice of the relator’s FCA and retaliation claims.Continue Reading Qui Tam Complaint Against Pharmacy Dismissed for Lack of Particularity
CMS Proposed Rule Adds Exceptions to Stark Law and Provides Additional Guidance and Clarification
We recently outlined the significant proposed changes to the Stark Law that the Centers for Medicare & Medicaid Services (CMS) released on October 9. The analysis was written for the American Health Lawyers Association’s (AHLA) Fraud and Abuse Practice Group and co-authored by Dickinson Wright attorney Rose Willis. In the article, the authors summarized the Proposed Rule, including:
- Changes related to a value-based care delivery model – With the ongoing shift from the traditional fee-for-service model to value-based payment and delivery model, the Proposed Rule addresses three new exceptions to the Stark Law focused on the value-based model.
Continue Reading CMS Proposed Rule Adds Exceptions to Stark Law and Provides Additional Guidance and Clarification