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Health Government Contracting

Read need-to-know updates, commentary, and analysis on Health issues written by leading professionals.

Telehealth Reaches Tipping Point – Now Included in OIG Audit Plan

by Tucker Arensberg, P.C. on

Telehealth has apparently reached the tipping point in its significance to the Medicare budget, because OIG has now announced that it will “review Medicare claims for telehealth services provided at distant sites that do not...more

A “House of Cards”: DOJ Drops Out of ManorCare FCA Case After Judge Excludes Expert Witness

by Arnall Golden Gregory LLP on

The Department of Justice (DOJ) filed a motion on November 17, 2017 to voluntarily dismiss its False Claims Act (FCA) case against HCR ManorCare, Inc. (ManorCare). Despite a years-long investigation, coupled with nearly three...more

Will DOJ Dismiss More Meritless Qui Tam Actions?

by Holland & Knight LLP on

Is the U.S. Department of Justice (DOJ) going to dismiss more meritless qui tam actions brought under the False Claims Act (FCA)? At a conference on Oct. 30, 2017, Michael Granston, the Director of DOJ's Civil Fraud Section,...more

The Expanding False Claims Act Materiality Requirement

by Holland & Knight LLP on

There is a renewed focus on the government’s activities for purposes of the False Claims Act (FCA) materiality analysis and as demonstrated by a number of recently issued decisions, the roster of relevant government actors is...more

A Dialogue With Corporate Counsel: Skadden’s Seventh Annual Pharmaceutical and Medical Device Seminar

Panelists examined major enforcement actions from 2017 and identified key trends. Aggressive Enforcement With a Decrease in High-Dollar Settlements. Panelists noted that the Department of Justice (DOJ) continues its...more

DOJ Should Dismiss Meritless False Claims Act Qui Tam Relator Claims

by Jones Day on

The Situation: Despite recently acknowledging the significant burden imposed by frivolous False Claims Act claims and affirming its statutory grant of power to dismiss meritless claims brought by relators, DOJ has maintained...more

CMS Rolls Back Mandatory Bundled Payment Programs

The Trump administration is putting the brakes on a payment model that gained steam across the health care industry under the Obama administration. The Centers for Medicare & Medicaid Services announced yesterday it is...more

Escobar: Year One

Universal Health Services, Inc. v. U.S. ex rel. Escobar, 136 S. Ct. 1989 (2016) was a landmark case in FCA jurisprudence. In Escobar, the Supreme Court held that the implied false certification theory can be a basis for...more

Tying GME Funding to Quality Metrics

by Dentons on

"Pay-for-performance" initiatives have become the norm within Medicare payment programs. However, Medicare funding for graduate medical education (GME) is still based on statutory formulae that are not linked to outcome or...more

Physician Practice Penalized by DOJ for 60-Day Overpayment Rule Violation

by Baker Ober Health Law on

The Department of Justice (DOJ) imposed False Claims Act penalties against First Coast Cardiovascular Institute (FCCI) for failing to work credit balances and repay overpayments to federal health care programs. On October 13,...more

Federal Government Will Seek Dismissal of False Claims Act Cases That Lack Merit

by Ruder Ware on

A top official in the U.S. Department of Justice (DOJ) recently announced a major change in the federal government’s position on claims brought under the False Claims Act (FCA). Michael Granston, the director of DOJ’s Civil...more

Williams Mullen On Call - November 2017

by Williams Mullen on

Welcome to the third edition of Williams Mullen On Call. In this edition, we are pleased to provide two very timely interviews. The first interview is with Mandy K. Cohen, MD, MPH, Secretary of the North Carolina Department...more

Third Circuit Confirms Government Knowledge Can Defeat Scienter and Materiality Requirements for False Claims Act Liability

by Jones Day on

The Situation: In Spay v. CVS Caremark Corp., the Third Circuit became the latest court of appeals to hold that, in False Claims Act litigation, scienter can be lacking when the government has knowledge of "the facts...more

DOJ Bows Out of ManorCare FCA Case

by Bass, Berry & Sims PLC on

After years of investigation and litigation, and on the eve of a highly anticipated trial, the government abandoned its FCA case against ManorCare, the nation’s second-largest operator of skilled nursing homes and assisted...more

Recent Case Highlights Risks of Paying Physicians for Routine Duties - Signed writing required, informal documentation may not be...

by Stinson Leonard Street on

Payments to physicians, even for routine, necessary duties, may cause referrals to the entity making the payments to be "prohibited referrals" under the Stark Law. This means the hospital or other entity should not have...more

“Always a bridesmaid, never a bride” Might Work for Stark Liability but Not the Anti-Kickback Statute

by Nossaman LLP on

Last Thursday, a jury in federal district court in St. Louis handed down a verdict in a False Claims Act (“FCA”) case that presents a laundry list of the challenges which can arise in a FCA case. ...more

Skilled Nursing Facilities Targeted in Government Enforcement Actions and Qui Tam Lawsuits

by Pepper Hamilton LLP on

Skilled nursing facilities (SNFs) have been the subject of multiple high-profile False Claims Act settlements in recent years, and new pronouncements and pending enforcement actions suggest that SNFs will continue to face...more

What the DOJ’s Potential Policy Shift on Qui Tam Actions May Mean for Businesses

by Polsinelli on

In a surprise announcement, the Department of Justice (DOJ) announced that the government will move to dismiss a qui tam action brought under the False Claims Act when it determines that the case has no merit. ...more

Unreliable Expert Collapses DOJ-Led False Claims Act Case

by Holland & Knight LLP on

False Claims Act cases often turn into battles of the experts. But only rarely does that battle turn into a rout. It did last week in a case out of the Eastern District of Virginia, United States ex rel. Ribik v. HCR...more

The Case of the Bashful Whistleblower

by Faegre Baker Daniels on

William Nash filed a whistleblower case against his former employer but wanted to remain anonymous so that his new employer wouldn’t know that he is—you guessed it–a whistleblower. William’s qui tam action alleged Medicaid...more

Medicaid Fraud Whistleblower Loses Bid To Keep His Name Out Of The Public Eye

by Farrell Fritz, P.C. on

False Claims Act whistleblowers expose themselves to significant risks by coming forward and asserting claims of fraud against the government. Often, the whistleblowers, called relators under the False Claims Act, would...more

Fourth and Fifth Circuits Rely on Escobar to Render Important Fraud Decisions

Recent decisions in the Fourth and Fifth Circuit Courts of Appeals demonstrate the central role that the Supreme Court’s Escobar decision continues to play in fraud litigation despite, or as a result of, continued uncertainty...more

Top Takeaways for Medicare Physician and Hospital Payments in 2018

by Holland & Knight LLP on

The Centers for Medicare & Medicaid Services (CMS) on Nov. 1, 2017, released the Medicare Hospital Outpatient Prospective Payment System (OPPS) and the Medicare Ambulatory Surgical Center (ASC) Payment System Final Rule for...more

CMS Announces New Policy for Biosimilars Payments Under Part B

by Goodwin on

As we previously reported, the Centers for Medicare and Medicaid Services (“CMS”) has been considering comments on a proposed rule regarding biosimilar payment policies. On Thursday, CMS issued a final rule for the 2018...more

Vitas Hospice and Chemed Corporation Settle Largest-Ever FCA Claim Against a Hospice

by Baker Ober Health Law on

Vitas Hospice, the largest for-profit hospice chain in the United States, and its owner, Chemed Corporation, agreed to pay $75 million to settle allegations that Vitas Hospice submitted false claims for hospice services...more

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