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How did a clerkship with Judge Merritt change the way Chris Climo approaches the practice of law? Find out more>

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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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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.

David Thornton Comments on Potential Problems for Hospitals that Manage Insurance Plans

Media Mentions

September 11, 2015

Bass, Berry & Sims attorney David Thornton was quoted in an article in Modern Healthcare about a whistleblower lawsuit involving two hospitals that had established self-funded insurance plans for employees. The lawsuit alleged that through these insurance plans that imposed high costs to employees, the hospitals drove up the wage index which in turn inflated Medicare payments. While the Department of Justice declined to get involved in the suit, it raises questions related to ERISA compliance. According to David, "when hospitals control their employee healthcare networks, it can raise potential conflicts of interest ... If a hospital is using employees' money to pay above-market prices or the plan is designed to push employees into networks that benefit the hospital, you have some real ERISA problems there. You need to know that these duties do exist, and there are penalties involved if you are not able to establish that you have acted in the best interest of the participants."

The full article, "Fraud Case Highlights Hazards for Hospitals with Insurance Plans," was published by Modern Healthcare on September 10, 2015 and is available online.


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