In a recent article for AIS Health – RADAR on Medicare Advantage, I discussed the Department of Justice’s (DOJ) focus on pursuing Medicare Advantage (MA) insurers for wrongdoing under the False Claims Act (FCA) related to recoupment of overpayments.
Continue Reading DOJ Focus on Medicare Advantage Insurers and FCA LiabilityFalse Claims Act Fundamentals: Reverse False Claims
Previous False Claims Act (FCA) Fundamentals posts have examined how violations of certain federal laws can potentially expose entities to FCA liability when they receive money from the government.
Continue Reading False Claims Act Fundamentals: Reverse False ClaimsSupreme Court Review of Key FCA Issues
For the February 2023 issue of the American Bar Association’s (ABA) Health Lawyer, the flagship publication of the ABA Health Law Section, I authored an article entitled “Recent False Claims Act Developments at the Supreme Court.”
Continue Reading Supreme Court Review of Key FCA IssuesDownload Now – 11th Annual Healthcare Fraud & Abuse Review
Bass, Berry & Sims is pleased to announce the release of the 11th annual Healthcare Fraud & Abuse Review examining important healthcare fraud developments in 2022.
Continue Reading Download Now – 11th Annual Healthcare Fraud & Abuse ReviewDOJ Releases Annual Civil Fraud Recovery Statistics and Results
On February 7, the Department of Justice (DOJ) released its annual report of civil fraud recoveries for the prior fiscal year, along with its accompanying press release highlighting its civil enforcement efforts. Our top ten observations from DOJ’s release include:
Continue Reading DOJ Releases Annual Civil Fraud Recovery Statistics and ResultsWatch Now | Healthcare Fraud & Abuse Annual Review Webinar
Bass, Berry & Sims released its 11th Annual Healthcare Fraud & Abuse Review in early February 2023. As a companion to the Review, we hosted a complimentary webinar which provided an overview and discussion of key focus areas covered in the Review.
Continue Reading Watch Now | Healthcare Fraud & Abuse Annual Review Webinar
Supreme Court Review of False Claims Act Scienter Standard
I was quoted in a recent Law360 article examining the potential impact of the U.S. Supreme Court’s decision to hear a pair of False Claims Act cases about the proper standard for establishing scienter under the False Claims Act.
Continue Reading Supreme Court Review of False Claims Act Scienter StandardSecond Circuit Holds False Claims Act Complaint Is Barred by SEC Filings
In July 2021, the U.S. District Court for the Eastern District of New York dismissed a False Claims Act complaint filed by CKD Project, LLC, an entity created for the purpose of filing the lawsuit, which alleged that Fresenius violated the federal Anti-Kickback Statute by over-paying physicians for a majority interest in certain dialysis centers in exchange for the physicians’ continued referrals.
Continue Reading Second Circuit Holds False Claims Act Complaint Is Barred by SEC FilingsCMS Proposed Rule Addresses Multiple Aspects of Medicare Advantage Program for 2024, Including an Overpayment Rule Update
On December 14, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that contemplates several changes to, and clarifications of, guidance for the Medicare Advantage (MA) program in coverage year 2024.
Federal Court Rejects Government’s Evidence of Anti-Kickback Statute Violations
Earlier this month, the U.S. District Court for the Northern District of Georgia entered an order critiquing the government’s lack of evidence in a criminal case alleging violations of the Anti-kickback Statute (AKS).
Continue Reading Federal Court Rejects Government’s Evidence of Anti-Kickback Statute Violations