Health Government Contracting

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Failure to Disclose Best Pricing: Pharmaceutical Companies Settle FCA Claims for $784 Million

The Department of Justice announced late last month that pharmaceutical manufacturers Wyeth and Pfizer would pay $784 million to resolve a False Claims Act investigation and qui tam lawsuit arising from Wyeth’s failure to...more

Trove of SNF Claims Data Released By CMS – Ready for Mining By Auditors and Whistleblowers

Over recent years, the Federal government has trained its sights on potential billing abuses in the Medicare Part A program for Skilled Nursing Facilities (“SNFs”) in the provision of rehabilitation therapy services. The...more

OIG Releases Revised Policy Statement on Exclusion Authority

On April 18, 2016, the Office of Inspector General of the Department of Health and Human Services (OIG) released a revised policy statement on its exclusion authority, entitled Criteria for Implementing Section 1128(b)(7)...more

OIG Issues Revised Policy Statement Regarding Permissive Exclusion

On April 18, 2016, the Office of Inspector General of the United States Department of Health and Human Services (“OIG”) issued a revised policy statement containing the new criteria that OIG intends to use in implementing its...more

OIG Issues New Exclusion and CIA Guidance

On April 18, 2016, Inspector General Daniel R. Levinson announced the publication of updated guidance on how the Office of Inspector General (OIG) makes decisions about using its permissive exclusion authority and requiring...more

CMS publishes final Medicaid managed care rule

On April 25, 2016, the Centers for Medicare & Medicaid Services (CMS) released its long-awaited Medicaid managed care Final Rule, the first update to Medicaid managed care regulations since 2002, and implements dozens of...more

Illinois Governor Initiates Fight Against Health Care Fraud Amid Growing Deficit

As Illinois' finances continue to deteriorate and the budget crisis remains unsolved, the Rauner administration recently announced an initiative to focus on identifying and recouping health care fraud in Illinois. On April 5,...more

Justices Grapple with Limits of False Claims Act Liability in Implied Certification Cases

Last week the Supreme Court heard oral argument in a False Claims Act (“FCA”) case in which the Court is considering the validity of the so-called implied false certification theory. This theory attaches FCA liability when a...more

CMS Proposes to Reverse 0.2 Percent IPPS Rate Reduction After Two-Midnight Rule Litigation Loss

In the FY 2017 IPPS Proposed Rule, CMS announced that it would reverse the 0.2 percent IPPS rate cut that was imposed in FY 2014 (and re-adopted in subsequent years) related to the Two Midnight Rule and increase the...more

Implied Certification Liability under the FCA Could Expose Companies to Unforeseen Liability

The Supreme Court on April 19, 2016, heard oral arguments in Universal Health Services v. United States ex rel. Escobar, a case which will impact all government contractors—especially defense companies—as well as any health...more

Federal Court Rejects Hospitals’ Challenge to Medicare Wage Rule 

In a decision with far-reaching implications within the health care industry, on February 22, 2016, a federal judge rejected a challenge to how Medicare reimbursement is adjusted based on local labor costs, dismissing...more

Implied Fraud Under the False Claims Act Hangs in the Balance

On April 19, 2016, the United States Supreme Court heard oral arguments in a hotly anticipated False Claims Act (FCA) case: Universal Health Services, Inc. v. United States ex rel. Escobar. The Court will decide whether the...more

Supreme Court Hears Oral Arguments in Significant False Claims Act Case

Our colleagues Jackie Baratian and Jason Popp summarize...the oral argument for Universal Health Services v. United Sates ex rel. Escobar heard by the U.S. Supreme Court on Tuesday, April 19th, laying out the various...more

Veterans Affairs to Permit Acquisition of Non-TAA-Compliant Drugs

In a significant policy reversal, the Department of Veterans Affairs (VA) has announced that it will require all covered drugs under the Veterans Health Care Act (VHCA) to be offered on Federal Supply Schedule (FSS)...more

A New Decision Under the False Claims Act Could be of Great Help to the Healthcare Industry

When it comes to the False Claims Act, the government usually wins, but a recent decision should provide the healthcare industry with a rare sigh of relief. The opinion in United States v. AseraCare Inc.1 acknowledges the...more

Health Care E-Note - April 2016

Patient care is not confined to a single office or exam room, or a single physician or other provider. Caring for patients these days now includes complex coordination among physicians, nurses, technicians, staff, management,...more

Insurer Actions Cut the Heart Out of Out-of-Network Providers

Aetna Life Insurance Company recently won a $37 million verdict against a group of Northern California surgical centers, Bay Area Surgical Management, LLC and its affiliates (collectively, Bay Area), for an alleged...more

Supreme Court Poised to Resolve Circuit Split on False Claims Act Liability Under Theory of Implied Certification

The U.S. Supreme Court is poised to resolve a circuit split over the False Claims Act (FCA) that could have broad implications for those that do business with the federal government. On April 19, 2016, the Supreme Court...more

"New HHS OIG Criteria to Guide Resolution of Health Care Investigations"

The Office of Inspector General of the Department of Health and Human Services (OIG) has issued updated guidance on the use of its so-called permissive exclusion authority under Section 1128(b)(7) of the Social Security Act...more

SCOTUS Oral Argument Suggests FCA Implied Certification Theory Is Here to Stay – But Perhaps with Limits

Oral argument in Universal Health indicates Justices disinclined to categorically reject False Claims Act implied certification theory, though may limit its scope. On April 19, 2016, the United States Supreme Court heard...more

Supremes Hear Argument on Implied Certification Theory

On April 19 the U.S. Supreme Court heard oral argument in Universal Health Services v. U.S. ex rel. Escobar. That’s the case in which the First Circuit upheld a whistleblower suit brought against a mental health clinic that...more

Ninth Circuit Denies Medicare Payments in Assets-Only Purchase Without Assignment of Provider Agreement

On April 11, 2016, the Ninth Circuit Court of Appeals ruled that a hospital was not entitled to Medicare payments in an assets-only purchase until the Buyer enrolled in the Medicare program because it did not accept the...more

Supreme Court Seeks Meaning in Falsity and Fraud in the False Claims Act

Oral arguments were heard Tuesday, April 19th by the U.S. Supreme Court in one of the most significant False Claims Act (FCA) cases the Court has dealt with in decades on an issue with very real impact on whistleblower suits...more

Did the FCA’s “Implied Certification” Theory Dodge a Bullet?

Yesterday’s argument before the Supreme Court in Universal Health Services, Inc. v. U.S. ex rel. Escobar had the potential to put false claims based on an “implied certification” in the crosshairs. Instead, based on the...more

Supreme Court Hears Arguments Regarding the Implied Certification Theory

On April 19, 2016, the United States Supreme Court heard oral arguments in the case of Universal Health Services v. U.S. ex rel. Escobar. The Universal Health Services case was brought by two relators whose child had been...more

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