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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.

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

Client Type: Individual

We obtained summary judgment on behalf of a group of 21 Tennessee physicians in federal litigation in Nashville challenging a regulation from Centers for Medicare & Medicaid Services (CMS). CMS attempted to significantly limit enhanced Medicaid reimbursements for primary care services provided to vulnerable populations for 2013 and 2014. The physicians argued, and the court agreed, that CMS' regulation was contrary to the language of the Medicaid reimbursement statute. Therefore, the court struck down the regulation as unlawful and concluded that TennCare is not entitled to recoup the enhanced payments made to the physicians. 

The case is Averett v. U.S. Department of Health and Human Services, No. 3:16-cv-02815, 2018 WL 558825 (M.D. Tenn. Jan 24, 2018).

For more information about the case, please read the official news release here.

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