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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

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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.

Bass, Berry & Sims Releases Annual Review of Healthcare Fraud Activity

March 16, 2016

Healthcare Fraud and Abuse Review 2015Five Year Recovery Haul by DOJ Exceeds $12.5 Billion as Scrutiny on Healthcare Industry Continues

Nashville, Tenn. (March 16, 2016) – Last year's healthcare fraud headlines were noteworthy as much for legal developments and U.S. Department of Justice (DOJ) pronouncements, as they were for the healthcare fraud recovery haul by the government, according to the annual "Healthcare Fraud and Abuse Review 2015" released today by Bass, Berry & Sims PLC.

The Review includes exhaustive coverage of healthcare-related False Claims Act (FCA) settlements from the past year organized by healthcare industry sector and detailed coverage of FCA legal developments that will shape the litigation of healthcare fraud issues in the coming year. The Review also includes an overview of regulatory enforcement efforts related to the Stark Law and the Anti-Kickback Statute.

In FY 2015, the federal government continued its recent string of impressive recoveries related to healthcare fraud matters. As the Review discusses, DOJ collected nearly $3.6 billion in civil fraud recoveries – of which $2.3 billion was related to false claims against federal healthcare programs. During the previous five years, civil fraud recoveries involving the federal healthcare programs have exceeded $12.5 billion. 

"There can be no question that healthcare providers should expect that the level of government scrutiny will only increase in the coming years," said Brian D. Roark, head of the firm's Healthcare Fraud Task Force, which authors the Review. "Whistleblower lawsuits are at an all-time high, and healthcare providers should closely monitor the government's enforcement results to identify potential risk areas within their industry."

The impact of DOJ's September 2015 release of the Yates Memo also will be an important issue for healthcare providers to follow in the coming year. As detailed in the Review, the Yates Memo includes a number of DOJ directives regarding the government's expectation of those companies seeking cooperation credit in connection with resolution of alleged wrongdoing. It also sets forth DOJ's sharpened focus on individual liability in connection with government investigations. 

"The Yates Memo is a wake-up call for companies and individuals facing healthcare fraud investigations regarding how DOJ will handle those matters,” said John E. Kelly, managing partner of the firm's Washington, D.C. office and former Assistant Chief for Healthcare Fraud with DOJ's Fraud Section. "Healthcare providers also should be aware of DOJ's expressed intention to make increased use of parallel civil and criminal investigations of healthcare fraud issues as a means of maximizing potential recovery where possible."

Last year also included notable developments in enforcement regarding physician compensation, as new record settlement figures were established, as detailed in the Review.

"The 2015 settlements involving physician compensation leave little doubt that arrangements with physicians, particularly with respect to fair market value and commercial reasonability, continue to be under the federal government's microscope," said Healthcare Fraud Task Force member Danielle Sloane. "The nature of the allegations and the resulting large settlements offer important lessons for healthcare facilities to consider in structuring physician compensation arrangements."

"Leaders from healthcare organizations must remain vigilant in monitoring the fraud and abuse issues confronting the healthcare industry," said Matthew M. Curley, a Healthcare Fraud Task Force member. "An understanding of the complex legal developments shaping the enforcement environment undoubtedly will shed considerable light on what healthcare providers can expect in the coming year."

Download the "Healthcare Fraud and Abuse Review 2015."

The release of the review coincides with the firm's launch of a new blog, Inside the FCA, available here. Inside the FCA will provide ongoing updates related to the False Claims Act, including insight on the latest legal decisions, regulatory developments and FCA settlements affecting federal programs and government contractors. 

About the Bass, Berry & Sims Healthcare Fraud Task Force 
The Bass, Berry & Sims Healthcare Fraud Task Force represents healthcare providers in connection with civil, criminal, and administrative fraud and abuse matters, including responding to government investigations by the U.S. Department of Justice, the Office of Inspector General of the U.S. Department of Health and Human Services, federal program safeguard contractors, and various states' Attorneys General offices, and in litigating fraud and abuse issues arising under the False Claims Act.

About Bass, Berry & Sims PLC
With more than 260 attorneys representing numerous publicly traded companies and Fortune 500 businesses, Bass, Berry & Sims PLC has distinguished itself for service to national healthcare clients, including hospitals, pharmaceutical companies and outpatient service providers. Ranked as one of the largest healthcare law firms in the U.S., Bass, Berry & Sims provides unsurpassed depth in mergers and acquisitions, investigations, compliance, regulatory and operational matters. For more information, visit

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