Health Government Contracting

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Worthless Services Investigations and Settlements: The Enforcement Trend Continues

In recent years, state and federal governments have shown their willingness to criminally pursue skilled nursing home owners and operators for allegedly administering “worthless” or substandard quality of care to their...more

The Pitfalls of Settling Qui Tam Lawsuits

In a recent federal court case, the federal government and the State of California successfully enforced an oral settlement agreement of a qui tam lawsuit against a health care provider. United States v. North East Medical...more

Is Health Care Fraud on the Rise? Or Just the Accusations??

Recent stories in the news seem to suggest that health care fraud is running rampant. We’ve got stories about Eric Leak‘s Medicaid agency, Nature’s Reflections, funneling money to pay athletes, a seizure of property in...more

Should Health Care Providers Pay Attention to the Seventh Circuit’s New Definition of “Referral”? – Part One

The Seventh Circuit Court of Appeals, in the case of United States v. Patel, just expanded the definition of “referring” under the federal Anti-Kickback Statute (“Statute”). In light of this case, health care providers should...more

$12.6 Million Sandoz ASP Reporting Settlement Raises More Questions Than It Answers

Recently, HHS-OIG announced a first-of-its-kind settlement over pharmaceutical manufacturer reporting of Average Sales Price (ASP). Sandoz, Inc. agreed to pay a civil monetary penalty of $12.64 million for alleged failure to...more

Health Care E-Note - March 2015

In This E-Note: - Health Care Reform in America: The Good, The Bad and The Ugly - The Federal False Claims Act - Violations of Conditions of Payment or Conditions of Participation? - State Regulatory...more

Federal Appeals Court Finds that New RAC Contracts Violate Federal Regulations

On March 10, 2015, the U.S. Court of Appeals for the Federal Circuit found that the Federal Acquisition Regulation (FAR) applies to CMS’s revised payment terms for new Recovery Audit Contractor (RAC) contract solicitations,...more

Fox Hollow Technologies Agrees to Settle False Claims Act Allegations

The United States Department of Justice recently announced that ev3 Inc., a company that recently acquired Fox Hollow Technologies, agreed to pay a $1.25 million penalty to settle accusations that Fox Hollow had committed...more

House to Vote Today on DMEPOS Competitive Bidding, Hospital Observation Policy, and Other Health Policy Bills

On March 16, 2015, the House of Representatives is scheduled to consider the following health policy legislation...more

Medical Device Companies Face Severe FCA Penalties for TAA Violations

A spate of recent multi-million dollar settlements has shown that medical device manufacturers are subject to substantial liability under the False Claims Act (FCA) if they misstate the country of origin of their products in...more

Circuit Court Provides Clarification of Pleading Standards in FCA Cases - The Court's Holding Details Requirements for Alleging...

A recent U.S. Court of Appeals case from the Seventh Circuit has brought further insight into the heightened pleading standard required under the False Claims Act (FCA). The case, Thulin v. Shopko Stores Operating Co., LLC,...more

Mintz Levin Health Care Qui Tam Update - Recent Developments & Unsealed Cases: March 2015

Trends & Analysis - ..We have identified 19 health care–related qui tam cases unsealed in November and December 2014. Of those cases, 17 were filed from 2012 to the present. The remaining two cases were filed in April...more

Dignity Health Pays $37 Million After Claims of Overbilling

Major whistleblower claims have been occurring in a wide variety of industries lately. One of the industries in which fraud is most prevalent is the health care industry, and this past fall an instance of fraud cost a...more

Judge Orders State’s Termination of Provider’s Medicaid Contract To Be REVERSED, Despite the Unilateral Termination!!

Imagine that the State of North Carolina knocks on your office door and informs you that you are no longer allowed to accept Medicaid and/or Medicare reimbursement rates. That for whatever reason, you are no longer allowed to...more

The Federal False Claims Act - Violations of Conditions of Payment or Conditions of Participation?

With the increase of Qui Tam lawsuits alleging violations of the federal False Claims Act ("FCA"), it is important to understand that FCA liability maybe predicated on whether the alleged wrongful act violated a condition of...more

CMS Rule on Medicare Overpayments? Don’t Hold Your Breath

Since the Center for Medicare & Medicaid Services proposed a rule three years ago suggesting that providers could be liable for returning Medicare overpayments going back ten years, providers have been anxiously awaiting a...more

FAR Part 12 Applies to CMS Orders on Federal Supply Schedule Contract

On Tuesday, March 10, 2015, the Court of Appeals for the Federal Circuit reversed and remanded a decision by the Court of Federal Claims, which permitted the Centers for Medicare and Medicare Services (CMS) to include...more

GAO Report Highlights Improper Medicare/Medicaid Payments

Despite the efforts of the Department of Health and Human Services (HHS) to combat fraud and contain costs in federal healthcare programs, Medicare’s fee-for-service program (Parts A and B) and Medicaid were two of the top...more

Narrowing Of FCA Public Disclosure Bar Continues

On Feb. 25, 2015, the Sixth Circuit became the latest federal court of appeals to weigh in on the scope of the False Claims Act’s public disclosure bar in its decision in United States ex rel. Whipple v. Chattanooga-Hamilton...more

Pro Se and Ex Rel. Don’t Mix, Even for Attorney Whistleblowers

William Verrinder filed a False Claims Act against three of America’s biggest companies—Wal-Mart, Sears and Rite-Aid—claiming they charged Medicare for expired drugs. Since he’s a lawyer himself, he filed pro se. That way he...more

There’s No Such Thing as Bad Publicity

As of March 3, Solvay Pharmaceuticals is ready to second P.T. Barnum’s famous dictum that there’s no such thing as bad publicity. That’s the day a federal court in Texas dismissed a qui tam action against Solvay....more

CMS Delays Publication of Final Rule Regarding Reporting and Returning of Medicare Overpayments

One of the most challenging compliance changes brought about by the Affordable Care Act (ACA) is the provision mandating the reporting and refunding of Medicare and Medicaid overpayments within 60 days of the date they are...more

CMS Call Letter: Medicare Advantage Contracting Considerations

As a final addition to our series on the 2016 Draft Call Letter, we highlight some of the MA contracting issues raised by the Centers for Medicaid and Medicare Services (“CMS”). Specifically, CMS (1) recommends Medicare...more

The FCA and the Ever-Narrowing Public Disclosure Bar

On February 25, 2015, the Sixth Circuit became the latest federal court of appeals to weigh in on the scope of the False Claims Act’s (FCA) public disclosure bar in its decision in United States ex rel. Whipple v....more

Eleventh Circuit Affirms Dismissal of Relator's Complaint Under Amended Public Disclosure Bar

In United States of America ex rel. Marc Osheroff v. Humana, Inc. et al., No. 13-15278 (11th Cir., Jan. 16, 2015), the Eleventh Circuit affirmed dismissal of a relator’s complaint under the public disclosure bar of the False...more

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