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Health Care Providers Remand

McDermott Will & Emery

Healthcare Regulatory Check-up Newsletter | March 2023 Recap

This issue of McDermott’s Healthcare Regulatory Check-Up highlights significant regulatory activity for March 2023. We discuss several criminal and civil enforcement actions that involve Anti-Kickback Statute (AKS) and...more

Foley Hoag LLP

American Hospital Association et al. v. Becerra et al.: Supreme Court Rejects CMS Policy to Adjust Medicare Part B Payments for...

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Earlier this week, the Supreme Court released its opinion in American Hospital Association et al. v. Becerra et al., a case that involves the proper method for the Medicare program to reimburse hospitals for outpatient drugs...more

American Conference Institute (ACI)

[Event] Drug & Medical Device Litigation - December 7th - 8th, New York, NY

The premier event for drug and medical device product liability lawyers to gain essential winning litigation strategies. ACI’s 26th Annual Flagship Conference on Drug and Medical Device Litigation is returning to New York...more

Hinshaw & Culbertson - Health Care

Improper Remarks During Closing Argument Reverse Defense Verdict: Hinshaw's Annual Guide to Key Illinois Medical Malpractice...

Can comments intended to inflame the passions of the jury, even if directed at a non-party, result in error? Michael Konewko v. Advocate Health and Hospitals Corporation d/b/a Advocate Good Samaritan Hospital 2020 IL App...more

Perkins Coie

AseraCare Settlement Ends Medical Judgment False Claims Act Case With a Whimper

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The U.S. Department of Justice (DOJ) has reached a settlement with hospice company AseraCare, closing a 12-year-old saga that carries substantial implications for False Claims Act (FCA) enforcement in cases involving a...more

Holland & Knight LLP

AseraCare Announces Settlement of Landmark False Claims Act Case for $1 Million

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After litigation spanning more than a decade, hospice provider AseraCare announced its $1 million settlement with the U.S. Department of Justice (DOJ) in a closely-watched False Claims Act (FCA) case in the U.S. District...more

K&L Gates LLP

K&L Gates Triage: Health Care Provider v. Payor Disputes Simplified: Getting Around ERISA Preemption

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In this week’s episode, Gary Qualls discusses the recent Louisiana federal district court decision in Crescent City Surgical Centre vs. United Healthcare of Louisiana, in which the court found that an out-of-network...more

Foley Hoag LLP - White Collar Law &...

Challenge to Attorneys' Fees in False Claims Act Cases

Thanks to inexact language in a settlement agreement, a for-profit hospital chain can challenge whistleblowers’ eligibility for attorneys’ fees under the False Claims Act (“FCA”). The single sentence that spawned nearly 5...more

King & Spalding

Eleventh Circuit Denies Preliminary Injunction for New National Liver Transplant Allocation Policy

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On September 25, 2019, the United States Court of Appeals for the Eleventh Circuit affirmed a lower court’s decision to deny a motion for a preliminary injunction to stay the implementation of the new policy for allocating...more

King & Spalding

False Claims Act Case Based on Stark Law Violations to Continue After the Third Circuit Revives Whistleblowers’ Claims

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On September 17, 2019, the U.S. Court of Appeals for the Third Circuit revived three whistleblowers’ claims alleging that the University of Pittsburgh Medical Center (UPMC) and neurosurgeons employed by three subsidiary...more

Baker Donelson

Disagreements over a Medical Judgment Cannot Form the Basis for Liability Under the False Claims Act

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A new federal court decision offers a ray of light to those providers defending false claims actions based on an alleged lack of medical necessity. On September 9, 2019, the United States Court of Appeals for the Eleventh...more

Troutman Pepper

Eleventh Circuit Says Difference Of Opinion Does Not Establish Falsity In False Claims Act Case

Troutman Pepper on

On September 9, in a setback for AseraCare but an overall win for hospice providers, the Eleventh Circuit affirmed a Northern District of Alabama decision to grant a new trial in a False Claims Act (FCA) case against...more

Sheppard Mullin Richter & Hampton LLP

The Eleventh Circuit Remands AseraCare, But Affirms High Hurdle for Proving Falsity

In a highly anticipated opinion in the AseraCare case, issued on September 9, 2019, the Eleventh Circuit Court of Appeals affirmed the district court’s holding that “a clinical judgment of terminal illness warranting hospice...more

Mintz - Health Care Viewpoints

Eleventh Circuit Rules in AseraCare Case that Disagreements in Clinical Judgment, Without Objective Falsity, Do Not Prove Fraud...

On Monday, the U.S. Court of Appeals for the Eleventh Circuit issued its long-awaited and closely watched decision in United States v. AseraCare Inc.. The court ruled that a claim cannot be deemed false under the False Claims...more

Foley Hoag LLP - White Collar Law &...

Eleventh Circuit Holds Differences in Clinical Judgment Do Not Create FCA Liability for Hospice Provider

The Eleventh Circuit agreed with the trial court that the government must do more than present expert evidence that a physician’s clinical judgment was inaccurate to establish falsity under the False Claims Act. Nonetheless,...more

K&L Gates LLP

K&L Gates Triage: Recent Developments Impacting Drug Pricing and the 340B Program: Part 2

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In Part Two of this two-part series on recent developments in pharmacy law and the 340B drug pricing program, Richard Church and Ryan Severson discuss several recent developments related to the 340B drug pricing program,...more

Hogan Lovells

Eleventh Circuit Confirms: Mere Difference of Opinion Between Physicians Does Not Establish Falsity Under the False Claims Act

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More than two years after the Northern District of Alabama granted summary judgment in a False Claims Act (FCA) case in favor of AseraCare Inc., holding that “contradiction based on clinical judgment or opinion alone cannot...more

Morgan Lewis - Health Law Scan

The Zombification of Auer: Supreme Court Cabins Agency Deference in Kisor v. Wilkie

Paired with the recent decision in Azar v. Allina, the healthcare industry in particular can hope for a greater voice in the regulatory process in the wake of the US Supreme Court’s directives. With Allina’s requirement that...more

King & Spalding

Federal Court Declines to Vacate Secretary’s Ultra Vires 340B Rate Cut and Remands to CMS to Fashion Proper Remedy

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In a long-awaited ruling, on May 6, 2019, Judge Rudolph Contreras of the U.S. District Court for the District of Columbia declined to vacate the Secretary’s CYs 2018 and 2019 Outpatient Prospective Payment System (OPPS)...more

K&L Gates LLP

K&L Gates Triage: Medicare Overpayment Recoupment Halted by Court

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In a recent decision, the Northern District of Texas, Dallas Division, granted a health care provider a preliminary injunction to prevent the Centers for Medicare & Medicaid Services ("CMS") from withholding Medicare payments...more

Baker Donelson

Court of Appeals Reverses D.D.C. Order Requiring HHS to Eliminate Medicare Appeals Backlog by December 31, 2020

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Hopes were dashed for sooner relief from the backlog of Administrative Law Judge (ALJ) appeals. With the backlog of Medicare reimbursement appeals steadily growing, a reversal by the U.S. Court of Appeals for the District of...more

Faegre Drinker Biddle & Reath LLP

Professional Review Activity or Professional Review Action?

Was the Louisville hospital’s restriction of Dr. Ben Reid’s surgery privileges a professional review activity or a professional review action? When Ben sued on various tort theories, the hospital claimed immunity under the...more

Bass, Berry & Sims PLC

Deeper Dive: Meeting the FCA’s Intent Requirement

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The FCA continues to be the federal government’s primary civil enforcement tool for investigating allegations that healthcare providers or government contractors defrauded the federal government. In the coming weeks, we will...more

Snell & Wilmer

Is Your Arbitration Agreement Enforceable?

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Health care providers may favor arbitration due to the perception that it is a faster, less expensive alternative to litigation. State and federal policy favors arbitration for the same reasons.  Because of the strong public...more

Bass, Berry & Sims PLC

On Remand, First Circuit Finds Violations in Escobar Were Material

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In June, the Supreme Court issued Universal Health Services, Inc. v. U.S. ex rel. Escobar, a landmark opinion in which the Supreme Court addressed the standard for pleading materiality in FCA implied certification cases. The...more

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