On June 1, 2023, the Supreme Court of the United States (SCOTUS) issued its much-anticipated opinion in United States ex rel. Schutte v. SuperValu Inc. and United States ex rel. Proctor v. Safeway, Inc. (Schutte), holding...more
6/21/2023
/ Drug Pricing ,
False Claims Act (FCA) ,
Fraud ,
Government Investigations ,
Healthcare ,
Pharmaceutical Industry ,
Pharmacies ,
Prescription Drugs ,
Reasonable Interpretations ,
Scienter ,
SCOTUS ,
US ex rel Thomas Proctor v Safeway Inc ,
US ex rel Tracy Schutte et al v SuperValu Inc et al
Signaling its continued scrutiny of the laboratory industry, the Department of Justice (DOJ) entered into a settlement agreement with Texas lab Genotox Laboratories Ltd. last month related to compensation Genotox paid to...more
On March 28, 2023, the United States Court of Appeals for the Sixth Circuit issued its opinion in United States ex rel. Martin v. Hathaway, holding that plaintiffs in False Claims Act (FCA) cases alleging a violation of the...more
The Department of Justice (DOJ) recently announced its False Claims Act (FCA) Recoveries for 2022, with the second-highest number of settlements in history. While the number of settlements increased, the total amount of...more
As a product of the Department of Justice’s newly minted Corporate Crime Advisory Group, the DOJ has issued follow-up guidance to its October 2021 memo on corporate criminal enforcement, which reinstated prior guidance...more
Co-Location and the Provider-Based Rules – No News is…Good News?
On July 15, the Centers for Medicare & Medicaid Services ("CMS") released the 2023 Outpatient Prospective Payment System proposed rule (“OPPS Proposed...more
9/15/2022
/ Centers for Medicare & Medicaid Services (CMS) ,
Critical Access Hospitals ,
Health Care Providers ,
Health Insurance ,
Healthcare ,
Healthcare Reform ,
Medicare ,
No Surprises Act (NSA) ,
Outpatient Prospective Payment System (OPPS) ,
Payor Contracts ,
Surprise Medical Bills
Wednesday, the United States Supreme Court handed down a highly anticipated, unanimous opinion, AHA v. Becerra, confirming that CMS exceeded its statutory authority when it implemented a discriminatory reimbursement structure...more
6/17/2022
/ American Hospital Association ,
American Hospital Association et al v Becerra Secretary Of Health And Human Services et al ,
Centers for Medicare & Medicaid Services (CMS) ,
Health Care Providers ,
Health Insurance ,
Hospitals ,
Lack of Authority ,
Medical Reimbursement ,
Medicare ,
Medicare Part B ,
Outpatient Prospective Payment System (OPPS) ,
Prescription Drugs ,
SCOTUS ,
Section 340B ,
Statutory Authority
Behavioral Health M&A Will Remain Hot in 2022 -
Behavioral health had its most active year in 2021, which came on the heels of very active years that preceded it. There are many factors that contributed to this and that...more
Recently, HRSA verbally confirmed that it has assigned Administrative Dispute Resolution (ADR) panelists, a key development to move a handful of pending ADR complaints forward. Those complaints contain allegations that drug...more
Over the past year, the federal government has taken concrete steps to fulfill its promise of a heightened commitment to investigating and enforcing health care fraud within the Medicare Advantage program (Medicare Part C). ...more
9/27/2021
/ Centers for Medicare & Medicaid Services (CMS) ,
Department of Justice (DOJ) ,
Enforcement Actions ,
False Billing ,
False Claims Act (FCA) ,
Health Care Providers ,
Health Insurance ,
Healthcare Fraud ,
Medical Reimbursement ,
Medicare ,
Medicare Advantage ,
Medicare Advantage Organizations (MAOs) ,
Medicare Part C
The Washington Department of Health (DOH) has amended WAC 246-50, the rules applicable to coordinated quality improvement programs (CQIPs) for non-hospital organizations. The amendments go into effect on May 21, 2021. ...more
On January 14, 2021, the United States Department of Justice (DOJ) announced that it had recovered $2.2 billion from False Claim Act (FCA) Cases during 2020. Each year, the DOJ publishes statistics about its recoveries under...more
Over the last several years, antitrust prosecutors at the Department of Justice have repeatedly cautioned that anticompetitive agreements affecting labor markets can be the subject of criminal prosecution under the antitrust...more
12/18/2020
/ Anti-Competitive ,
Antitrust Investigations ,
Antitrust Provisions ,
Criminal Conspiracy ,
Criminal Prosecution ,
Department of Justice (DOJ) ,
Enforcement Actions ,
Federal Trade Commission (FTC) ,
Health Care Providers ,
Restrictive Covenants ,
Wage-Fixing
The Washington Department of Health (DOH) has filed a notice of proposed rule-making that may be of interest to a broad cross-section of the Washington health care community. DOH has proposed to amend the rule that provides...more