News & Analysis as of

Public Disclosure Medicare

King & Spalding

Court of Appeals Upholds CMS Rule Requiring Public Disclosure of Prices Negotiated Between Hospitals and Insurance Companies

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On December 29, 2020, the U.S. Court of Appeals for the District of Columbia Circuit upheld a CMS final rule promulgated in November 2019 that requires hospitals to disclose various forms of pricing information related to the...more

Sheppard Mullin Richter & Hampton LLP

Is Prescription Drug Pricing The Cure For Partisanship?

In a rare act of bipartisanship, Senate Finance Committee Chairman Chuck Grassley, R-Iowa, and Ranking Member Ron Wyden, D-Ore., introduced on July 23rd a chairman’s mark, the Prescription Drug Pricing Reduction Act (PDPRA)...more

Bass, Berry & Sims PLC

Adding Insult to Injury: When an FCA Complaint Begets Follow-On Corporate Litigation

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The Delaware Supreme Court recently affirmed a decision by the Delaware Court of Chancery addressing a plaintiff’s ability to acquire key documents from a defendant company based on allegations against that company in an...more

Holland & Knight LLP

CMS Proposed Rule CMS-1694-P — Hospital Pricing and Electronic Medical Records: Increasing Patient Access

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On April 24, 2018, the Centers for Medicare and Medicaid Services (CMS) issued for comment a 1883-page proposed rule (CMS-1694-P) (the "Proposed Rule") that aims, among other goals, to increase transparency relating to...more

Bass, Berry & Sims PLC

Healthcare Fraud & Abuse Review 2017

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A LOOK BACK... A LOOK AHEAD - While the uncertainty associated with legislative efforts to repeal the Patient Protection and Affordable Care Act (PPACA) dominated most of the headlines for the healthcare industry last year,...more

Dorsey & Whitney LLP

First Circuit Affirms Dismissal For CVS Caremark Under Public Disclosure Bar

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The FCA’s public disclosure bar precludes liability when a relator’s allegations have been publicly disclosed in a list of statutorily enumerated sources. Last week, the First Circuit added to the growing jurisprudence both...more

Faegre Drinker Biddle & Reath LLP

Whistleblower Filed Too Early & Too Late for Share of $322M SCAN Scam Recovery

During his days as a data encounter manager at SCAN, Jim suspected the company had been double-billing Medicare and Medicaid for years. He expressed his concerns within SCAN. When he refused a job reassignment, he was fired....more

Dorsey & Whitney LLP

Ninth Circuit Unanimously Overrules Long-Standing “Original Source” Precedent; Makes it Easier to Qualify as an Original Source...

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For 23 years, the Ninth Circuit required that a relator establish three elements to qualify as an “original source” under the False Claims Act: (1) the relator must have direct and independent knowledge of the information on...more

Morrison & Foerster LLP

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

Blank Rome LLP

Friday Afternoon Smackdown – The SEC v. The House Of Representatives

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On Friday, June 20, 2014, the Securities and Exchange Commission filed an action against the Committee on Ways and Means of the U.S. House of Representatives and congressional staffer Brian Sutter seeking enforcement of...more

Bradley Arant Boult Cummings LLP

False Claim Act: 2013 Year in Review

Last year continued the trend of robust False Claims Act (FCA) enforcement by the U.S. Department of Justice (DOJ) and proliferating qui tam lawsuits brought by whistleblowers on behalf of the United States. In 2012, DOJ...more

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