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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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Eleventh Circuit Refines Public Disclosure Bar Standards

Publications

January 20, 2015

The Eleventh Circuit affirmed the district court's dismissal of a relator's qui tam lawsuit under the FCA's public disclosure bar and, in doing so, concluded that the ACA's amendments to the public disclosure bar created grounds for dismissal for failure to state a claim, rather than for lack of jurisdiction. In U.S. ex rel. Osheroff v. Humana, Inc., the relator alleged that various Florida-based clinics and health insurers violated the FCA through the provision of various services to patients as kickbacks designed to induce and influence the patients' healthcare decision-making. Defendants pointed to allegations in state court litigation and news media as publicly disclosing the allegations upon which the relator based his qui tam lawsuit, and the district court agreed.

According to the Eleventh Circuit, dismissal of the relator's lawsuit was appropriate because the lawsuit was based at least "in … part" upon the publicly disclosed information cited by defendants. The relator also did not qualify as an original source of the information in his complaint. Under the pre-ACA original source exception, the relator was not an original source because he offered nothing more than "background information that helps one understand or contextualize [the] public disclosure." And, under the post-ACA original source exception, the relator had not materially added to the public disclosures, which already were sufficient to give rise to an inference of wrongful conduct.

The U.S. District Court for the Middle District of Tennessee reached a similar conclusion concerning similar allegations made by the same relator in U.S. ex rel. Osheroff v. HealthSpring, Inc., No. 3:10-cv-01015 (M.D. Tenn.).

For more information, visit www.InsidetheFCA.com.


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