News & Analysis as of

Fourth Circuit Grants Review of Use of Statistical Sampling in False Claims Act Case to Prove Liability and Damages

On September 29, 2015, the United States Court of Appeals for the Fourth Circuit agreed to hear on interlocutory appeal the controversial issue of reliance on statistical sampling in a whistle-blower action to prove liability...more

Reporting for ACA Mandates: Final Forms and Additional Guidance

The IRS has finalized the 2015 forms and instructions for reporting under the individual and employer mandates and issued additional guidance on these new reporting requirements. The following forms are now available...more

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

Trends & Analysis - Since our last Qui Tam Update, we have identified 39 health-related False Claims Act (“FCA”) qui tam cases that have been unsealed. Of those cases...more

Final 2015 Forms 1094-B, 1095-B, 1094-C, 1095-C and Instructions

On September 16, 2015, the IRS finalized these ACA coverage reporting Forms and Instructions... We report here, with minimal analysis, changes that we recognized on first comparison to the 2015 Draft Forms and Instructions....more

Employee Benefits Alert - August 2015

Retirement Plans - IRS Issues Guidance on Benefit Suspension Voting under MPRA - As we have written in prior alerts, the Multiemployer Pension Reform Act of 2014 (MPRA) permits trustees of financially troubled...more

When the Government Comes Knocking

This article will provide an outline of some of the most significant points for hospitals to use when confronted with a formal government investigation under the Criminal or Civil False Claims Act. As noted below, you should...more

Hospital Chain Pays Heavy Price for Being Too Clever

Finding that Community Hospital Systems had been “too clever by half” in negotiating a global settlement agreement for seven whistleblower suits, a federal judge ordered the chain to pay the attorneys’ fees of all the...more

Important Tax Provisions Contained in Acts Extending Highway Trust Fund and Trade Preferences

On July 31, 2015, President Obama signed P.L. 114-41, the Surface Transportation and Veterans Health Care Choice Improvement Act of 2015 (“Highway Act”), into law. Although the Highway Act is primarily for the purpose of...more

Bill Would Extend CMPs to Federal Grants

The bill known as the “21st Century Cures,” H.R.6, would extend Civil Monetary Penalties (CMPs) to cover false claims and false statements relating to grants, contracts, and other agreements funded by the Department of Health...more

Health Care E-Note - April 2015

In This Issue: - New Smartphone Software Provides Groundbreaking Opportunity for Medical Research - The Many Levels of Supervision - Health Care Business Today: A Historical Perspective on Health Care...more

Partial Relief for Employer Payment of Individual Insurance Premiums

In a recent notice, the Internal Revenue Service has tempered prior guidance that closed the door on employer arrangements for paying the cost of individual health insurance for employees. The IRS still views these premium...more

IRS Clarifies Prior Guidance on Premium Reimbursement Arrangements; Provides Limited Relief

Continuing its focus on so-called “premium reimbursement” or “employer payment plans”, the Internal Revenue Service (IRS) released IRS Notice 2015-17 on February 18, 2015. In this Notice, which was previewed and approved by...more

False Claims Act – 2014 Year in Review

The False Claims Act (FCA) imposes liability on individuals and companies who defraud or submit false claims to the federal government. The FCA allows the federal government to seek treble damages, civil penalties and...more

Medical Insurance Premium Reimbursement — A Brief Reprieve for Small Employers

Some employers – particularly smaller ones – have assisted their employees to obtain health insurance by reimbursing them for the cost of insurance they purchase in the individual market. Does this practice satisfy the...more

Supplemental Excepted Benefits? “It depends.”

Last week, HHS, along with the Department of Labor and the Treasury, provided long overdue guidance regarding the third category of supplemental “excepted benefits” as defined by Section 2791 of the Public Health Services...more

House Approves Bills to Modify ACA Rules for Employers Related to Part-Time Workers, Veterans

On January 8, 2015, the House of Representatives approved H.R. 30, the “Save American Workers Act.” The legislation would amend the ACA’s definition of “full-time employee” for purposes of the requirement that certain...more

Employing Veterans May Help Avoid the ACA’s Employer Mandate

The new Republican Congress began its session with an attempt to narrow the Affordable Care Act’s (ACA) employer mandate by exempting certain veterans and their families from counting toward the number of employees at small...more

Blog: DOJ’s Record Year for FCA Recoveries Includes $2.3 Billion for Health Care Fraud

The Department of Justice (DOJ) announced this week that it recovered a record $5.69 billion in civil False Claims Act (FCA) settlements during fiscal year 2014. This recovery included $2.3 billion for FCA cases involving...more

DC Circuit Dismisses Appeal By Three Hospitals Challenging Subcontractor Status

On November 14, 2014, the United States Court of Appeals for the District of Columbia dismissed as moot an appeal by three hospitals affiliated with the University of Pittsburgh Medical Center. The hospitals had challenged...more

Do Subsidized Health Care Plans Purchased Under the Affordable Care Act Trigger the Anti-Kickback Statute?

The advent of federally subsidized private pay health insurance under the Affordable Care Act has the potential to expand the application of the federal anti-kickback statute beyond just Medicare, Medicaid, and Tricare. The...more

Healthcare Legal News - July 2014 • Volume 4, Number 2

In This Issue: - DO SUBSIDIZED HEALTH CARE PLANS PURCHASED UNDER THE AFFORDABLE CARE ACT TRIGGER THE ANTI-KICKBACK STATUTE? The advent of federally subsidized private pay health insurance under the Affordable...more

Drug Distributor and Pharmacies Obtain Partial Dismissal of State and Federal FCA Claims

On June 10, 2014, a New York federal court dismissed, in part, state and federal False Claims Act (FCA) claims brought against Novartis Pharmaceuticals Corporation and pharmacies to which it distributed (CVS Caremark Corp.,...more

The OFCCP Calls a Moratorium on Enforcement Activities Against TRICARE Providers

On May 7, 2014, a Directive of the Office of Federal Contract Compliance Programs (“OFCCP”) placed a five-year moratorium on enforcement activities regarding health care providers that are TRICARE subcontractors. TRICARE is...more

Victory in House of Representatives for Improvements to WOSB Federal Contract Program

On May 7, 2014, the Office of Federal Contract Compliance Programs (OFCCP) issued Directive 2014-01, instituting a five-year moratorium on the OFCCP enforcement over TRICARE subcontractors. The moratorium applies to health...more

OFCCP’s New Tricare Moratorium Directive: Delay of Game

On March 7, 2014, the Office of Federal Contractor Compliance Programs (OFCCP) issued Directive 2014-01, TRICARE Subcontractor Enforcement Activities concerning the affirmative action obligations of subcontractors of...more

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