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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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Download the Healthcare Fraud & Abuse Review 2017, authored by Bass, Berry & Sims

The Healthcare Fraud & Abuse Review 2017 details all healthcare-related False Claims Act settlements from last year, organized by particular sectors of the healthcare industry. In addition to reviewing all healthcare fraud-related settlements, the Review includes updates on enforcement-related litigation involving the Stark Law and Anti-Kickback Statute, and looks at the continued implications from the government's focus on enforcement efforts involving individual actors in connection with civil and criminal healthcare fraud investigations.

Click here to download the Review.

Event Recap: 2016 Health Care Investors Conference


October 20, 2016

Health care investors and executives gathered last week in Nashville for the sixth annual Health Care Investors Conference (HCIC), hosted by Bass, Berry & Sims and Deloitte & Touche LLP. 

Speakers discussed trends in healthcare investing and the potential impact of the 2016 elections. Themes included MACRA implications, investment insights and common deal busts. 

Several speakers analyzed implications of the Medicare Access and CHIP Reauthorization Act of 2015 (better known as MACRA), and its final rule released by CMS earlier this month.

Ryan Haggerty, Senior Manager in Deloitte & Touche LLP, called MACRA a "game changer." "It repeals the SGR formula, setting updates to the Medicare Physician Fee Schedule (PFS) for all years in the future and offers significant financial incentives for health care professionals to participate in risk-bearing, coordinated care models and to move away from the traditional fee for service system" he said.

"MACRA requires entirely new ways of reporting (reimbursements), which requires new infrastructure, and the physician world is completely unprepared," said Patrick Solomon, chief development officer of physician services at AmSurg. Solomon displayed a 2016 Deloitte study which showed only 2 percent of doctors are ready for MACRA. "It's just a new pain point to drive physicians to join larger organizations," he said.

Casey Lynch, managing director of Altamont Capital Partners, warned investors that scale alone may not lead to sustained success. "We believe simply being bigger is not enough," Lynch said. "You've got to be better. If you're better at running your business, the scale and efficiencies will come."

Danielle O'Rourke, principal with Martin Ventures, outlined the types of health care technology her organization seeks for investment. "Technologies adopted through governmental mandate are generally not good investments for us," she said. Instead, O'Rourke's firm prefers technologies that either improve efficiencies and operations within the current health care system, or those driving changes to the system through transparency and accessibility.

Speakers also identified legal and financial issues that can bust deals including undiscovered Stark Law violations, heightened fraud and abuse enforcement and purchase price adjustment disputes. Matt Curley, member, Bass, Berry & Sims, discussed the heightened enforcement environment facing healthcare companies, pointing out that the federal government has amassed more than $20 billion in civil fraud recoveries during the past five years. The Yates Memo, released by the U.S. Department of Justice in late-2015, outlines DOJ's policy of holding individuals accountable for civil and criminal wrongdoing uncovered in connection with corporate fraud investigations. He said, "Executives and board members of healthcare companies should take notice of the government's enforcement initiatives and work to create an environment of compliance within their organizations as a proactive means of reducing enforcement risk."

Angela Humphreys, chair of the Bass, Berry & Sims health care practice, and Deloitte & Touche LLP's Phil Pfrang, U.S. Managing Partner for life sciences & health care M&A transaction services, served as leaders of the event designed to connect investors with prominent players in the health care industry. 

"Investors have long recognized the entrepreneurial vigor and creativity of Nashville's health care community, making Nashville a natural location to bring together great leaders from the health care and private equity worlds over the past six years," said Humphreys. "It is a dynamic, transformative time in health care: Consolidation is at an all-time high, and everyone is trying to figure out what sectors to watch next. The speakers gave us all some truly valuable insight into that. We're grateful to Deloitte and pleased that our conference enables investors and management teams to connect."

Supporting organizations included the Nashville Entrepreneur Center, Healthcare Private Equity Association (HPCEA), the Nashville Health Care Council and Nashville Capital Network.

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