Healthcare is one of the most highly regulated industries in the country and providers of all types will eventually be called to action, whether it be responding to an investigation, conducting a compliance review, or proceeding with a self-disclosure. Bass, Berry & Sims has designed the Healthcare How-To Instructional Webinar Series to provide simple step-by-step instructions and best practices for responding accurately and efficiently while avoiding bad tactics, questionable strategies, and unnecessary risk, which can create problems and less than ideal outcomes.
False Claims Act Fundamentals: What Is a False Claim?
The False Claims Act, despite its name, does not define what it means for a claim to be “false” or “fraudulent.” This post examines the primary ways courts have interpreted the False Claims Act’s falsity element and discusses common issues that arise concerning falsity.
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False Claims Act Settlements to Know from Q1 2022
The first quarter of 2022 brought news of several noteworthy False Claims Act (FCA) settlements, including several settlements by physicians regarding arrangements deemed to be unlawful kickbacks and the first settlement under the Department of Justice’s Civil Cyber-Fraud Initiative. This post summarizes key settlements of interest to healthcare providers and government contractors.
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Fifth Circuit Affirms Criminal Healthcare Fraud Convictions of Hospice and Home Health Executives
On March 24, the U.S. Court of Appeals for the Fifth Circuit affirmed the criminal healthcare fraud convictions of two individuals who ran a network of home health and hospice centers in Texas. According to the Fifth Circuit, the defendants operated a “reimburse-first-verify-later system” for nearly ten years, under which an estimated 70 to 85 percent of patients were ineligible for the care they received. The Fifth Circuit provided colorful examples to show that “many certifications were not borderline cases”:
False Claims Act Decisions to Know from Q1 2022
There have been several significant rulings on various provisions of the False Claims Act (FCA) in the first quarter of this year, which we highlight in this post.
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False Claims Act Fundamentals: How to Respond to a Civil Investigative Demand
What Is a Civil Investigative Demand
A civil investigative demand (CID) is a tool, like a subpoena, that the government uses to obtain documents and information to investigate potential violations of the False Claims Act.
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False Claims Act Fundamentals: Elements of the False Claims Act
The False Claims Act, 31 U.S.C. § 3729, et seq. is the federal government’s primary and most effective tool for fighting fraud. This post provides an overview of the elements that plaintiffs must satisfy to establish liability under the False Claims Act and common defenses related to the elements.
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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.
Register Now: Healthcare Fraud & Abuse Annual Review Webinar Replay | April 5 at Noon CT
Earlier this year, Bass, Berry & Sims released the 10th annual Healthcare Fraud & Abuse Review examining important healthcare fraud developments in 2021.
As a companion to the Review, we will replay a complimentary webinar on Tuesday, April 5, 2022, from 1:00 p.m.-3:00 p.m. ET / 12:00 p.m.-2:00 p.m. CT / 10:00-12:00 a.m. PT, which will provide an overview and discussion of key focus areas covered in the Review.
First False Claims Act Settlement under DOJ’s Cyber-Fraud Initiative
On March 8, the Department of Justice (DOJ) announced the first settlement under its Civil Cyber-Fraud Initiative, as Comprehensive Health Services, LLC (CHS), a global medical services provider, agreed to pay $930,000 in part to resolve False Claims Act (FCA) allegations regarding cyber fraud. The government alleged that CHS contracted with the State Department to provide a secure electronic medical record (EMR) system to store patients’ medical records and submitted claims for the costs of this work, but failed to disclose that it had not consistently stored patients’ medical records on a secure EMR system.
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