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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.

Federal Court Decides Hospital is Not a Consumer Reporting Agency


August 27, 2015

In a recent decision, the U.S. Court of Appeals for the Seventh Circuit held that Illinois' largest hospital system, Advocate Health Care, is not a "consumer reporting agency" for purposes of the Fair Credit Reporting Act ("FCRA"). The case, Tierney v. Advocate Health & Hospitals Corp., affirmed the judgment of the district court, granting the hospital's motion to dismiss.

The case arose from a data breach in which burglars stole four desktop computers from one of Advocate's administrative offices. The computers contained unencrypted private data relating to four million Advocate patients. Several patients filed a class action lawsuit alleging that Advocate violated the FCRA's requirement that a consumer reporting agency ("CRA") maintain reasonable procedures to ensure it does not furnish consumer reports to unauthorized third parties.

In affirming the district court's dismissal, the Seventh Circuit found that Advocate did not meet the FCRA's statutory definition of a CRA in multiple ways. Although Advocate regularly assembles patients' personal information, it does not do so "for monetary fees" as required by the FCRA. Neither was Advocate's assembly of consumer information for the purpose of furnishing consumer reports to third parties, also required for Advocate to be considered a CRA. The consumer information assembled by Advocate came solely from transactions or experiences between the patients and Advocate, and thereby was expressly excluded by statute from the definition of a "consumer report."

The court's decision in Tierney follows other decisions in data breach litigation that have rejected plaintiffs' attempts to push the envelope for CRA liability under the FCRA. That push is motivated by the generous remedial provisions of the FCRA, including the availability of statutory damages (without the need to prove actual damages) on a class-wide basis without a statutory cap. By recognizing commonsense limits to the FCRA's expansive definition of a CRA, Tierney provides helpful precedent for healthcare companies that find themselves in FCRA litigation.

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