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
Judge Chen’s Message to Medicare Advantage Providers: ICD Guidelines Aren’t Suggestions
On November 14, Judge Edward Chen in the Northern District of California issued rulings on the pending motions to dismiss in U.S. ex rel. Osnek v. Kaiser Permanente, granting in part and denying in part Kaiser’s motion to dismiss. Continue Reading Judge Chen’s Message to Medicare Advantage Providers: ICD Guidelines Aren’t Suggestions
False Claims Act Fundamentals: Self-Disclosures
When healthcare providers and other government contractors are subject to scrutiny for bills submitted to the government, it is often the result of a whistleblower complaint filed under the qui tam provisions of the False Claims Act.
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Insight on Request for Supreme Court Review of Anti-Kickback Statute’s Scope
I recently provided insight for a Law360 article outlining Pfizer’s request to have the Supreme Court weigh in on the scope of the Anti-Kickback Statute (AKS).
Continue Reading Insight on Request for Supreme Court Review of Anti-Kickback Statute’s Scope
False Claims Act Settlements to Know from Q3 2022
The third quarter of 2022 brought a number of noteworthy False Claims Act (FCA) settlements, including several over $20 million and one in the high nine figures. This post summarizes key settlements of interest to healthcare providers.
Continue Reading False Claims Act Settlements to Know from Q3 2022
Third Time is Not the Charm – Supreme Court Denies Cert. on Rule 9(b) Split Again
On October 17, the U.S. Supreme Court summarily denied three petitions asking the Court to resolve a growing circuit split on the application of Federal Rule of Civil Procedure 9(b) in False Claims Act lawsuits.
Continue Reading Third Time is Not the Charm – Supreme Court Denies Cert. on Rule 9(b) Split Again
Register Now | 8th Annual Nashville Healthcare Fraud Conference
Please join us for the 8th Annual Nashville Healthcare Fraud Conference hosted by Bass, Berry & Sims and the Tennessee Hospital Association. Eligible for more than seven hours of CLE credit (including ethics), this complimentary program will take place on December 8th in Nashville (full day). The conference will be broadcast virtually the mornings of December 15th and 16th. Continue Reading Register Now | 8th Annual Nashville Healthcare Fraud Conference
SDNY Ruling in Anthem Sends a Signal to Medicare Advantage Litigants
In a decision issued on September 30, Judge Andrew Carter of the U.S. District Court for the Southern District of New York denied Anthem Inc.’s motion to dismiss a government lawsuit filed in March 2020 claiming Anthem submitted inaccurate diagnosis data in conjunction with its Medicare Part C plans that resulted in alleged overpayments in violation of the False Claims Act (FCA).
Continue Reading SDNY Ruling in Anthem Sends a Signal to Medicare Advantage Litigants