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Primary Care Providers Win Challenge of CMS Interpretation of Enhanced Payment Law

With the help and support of the Tennessee Medical Association, 21 Tennessee physicians of underserved communities joined together and retained Bass, Berry & Sims to file suit against the Centers for Medicare & Medicaid Services to stop improper collection efforts. Our team, led by David King, was successful in halting efforts to recoup TennCare payments that were used legitimately to expand services in communities that needed them. Read more

Tennessee Medical Association & Bass, Berry & Sims

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Thought Leadership

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Thought Leadership Spotlight

Healthcare Transactions: Year in Review 2018Last year, CVS Health Corp. (NYSE: CVS) announced it would purchase health insurer Aetna Inc. (NYSE: AET) for $67.5 billion, a transaction that would be one of the biggest healthcare mergers in the past decade. The transaction raises an intriguing question: is this the beginning of a transformational shift in healthcare?

Recently, members of our healthcare group authored the Healthcare Transactions: Year in Review outlining 2017 M&A activity and drivers in the following hot healthcare sectors:

• Managed Care
• Hospitals
• Post-Acute Care—Home Health & Hospice
• Ambulatory Surgery Centers (ASCs)
• Healthcare Information Technology (HIT)
• Behavioral Health
• Physician Practice Management

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Aggressive False Claims Actions, Medical Necessity Determinations and Individual Liability Charges

Events

July 31, 2012

Bass, Berry & Sims healthcare fraud attorney, Anna Grizzle, will participate on the panel discussion, "Aggressive False Claims Actions, Medical Necessity Determinations and Individual Liability Charges" at the American Conference Institute's Advanced Forum on Healthcare Provider Disputes and Litigation on Tuesday, July 31. Assistant United States Attorney, Jeffrey W. Dickstein, will also participate in this panel discussion.

The topic of discussion will cover:

  • Minimizing your exposure to False Claims Act violations under Health Care Reform's expanded statute
  • Examining the key considerations, strategies and timing involved in the motion practice and procedural issues when it becomes necessary to litigate a FCA case
  • Ensuring diagnosis codes are properly submitted so that the provider is reimbursed for services offered
  • Reporting overpayments to the government within a defined period of time to avoid increased monetary penalties
  • Top 5 things to do now to diminish your risk of a government investigation
  • Developing a risk adjustment model that withstands government scrutiny billing, medical necessity, and other fraud.
  • Determining if a procedure was medically necessary and who authorized its performance
  • Mitigating the risks of billing for services not provided, billing for a level of service not provided, or miscoding a claim to obtain reimbursement
  • Conducting due diligence assessments to safeguard the provider against anti-kickback and Stark Law violations Individual Accountability
  • Working through available defenses to a Park charge
  • Insulating yourself from liability in the government's pursuit of individual providers for health care fraud
  • Preparing for the government’s increased focus on provider activity
  • Ensuring that service was provided within Medicare guidelines
  • Learning how to cope with corporate life under the government's microscope
  • Representing yourself accurately and producing documents to avoid false claims or obstruction of justice allegations
Download Document - ACI Healthcare Provider Disputes and Litigation Conference Brochure

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