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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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Healthcare Private Equity Compliance Checklist

The complex and ever-changing healthcare regulatory and enforcement environment, including increased focus on the role of private equity firms in their portfolio companies, make compliance a top priority for private equity firms investing in healthcare companies. The best way to limit your exposure as a private equity firm is to avoid a compliance misstep in the first place. Additionally, an effective and robust compliance program for your portfolio healthcare company makes it much more attractive to potential buyers and helps you avoid an unexpected and costly investigation or valuation hit down the road. Download the Healthcare Private Equity Compliance Checklist to assess whether your portfolio company's compliance program is up-to-date.

Click here to download the checklist.

FCA Deeper Dive: Rule 9(b) and the Pleading of the Alleged Fraud Scheme

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March 2, 2016

The FCA continues to be the federal government's primary civil enforcement tool for investigating allegations that healthcare providers or government contractors defrauded the federal government. In the coming weeks, we will take a closer look at recent legal developments involving the FCA. This week, we examine recent court decisions considering the level of specificity required of a relator under Rule 9(b) in pleading the alleged FCA fraud scheme.

While analyzing the circumstances of fraud is necessarily a case-by-case analysis, courts have applied decidedly different approaches to examining certain components of a fraudulent scheme, including the "who" and "when" requirements.

Several cases demonstrated the nuances in pleading the appropriate "who" with particularity in FCA complaints against a corporation. In United States v. Sanford-Brown, Ltd., 788 F.3d 696 (7th Cir. 2015), which involved claims against a college and its corporate parent, the Seventh Circuit held that allegations against the "Defendants" in general were insufficient to allow claims against the parent company to proceed.

With regard to the particularity required when identifying individuals who were involved in perpetuating a fraud alleged against a corporation, district courts have reached different results. In U.S. ex rel. Modglin v. DJO Global Inc., 2015 WL 4111709 (C.D. Cal. May 8, 2015), a district court held it was insufficient to identify relevant actors as employees or "personnel" of the defendant company; rather, "[a]t a minimum, relators must identify the [relevant individuals] by their job titles and/or responsibilities." In U.S. ex. rel. Cieszyksi v. LifeWatch Services, Inc., 2015 WL 6153937 (N.D. Ill. Oct. 19, 2015), however, the district court held the complaint sufficiently identified "LifeWatch generally as the entity responsible" and did not need to "identify by name or position each person involved in submitting the alleged false claims." See also U.S. ex rel. Gates v. Austal, U.S.A. LLC, 2015 WL 5782284 (S.D. Ala. Aug. 10, 2015) (complaint dismissed for failure to identify specific claim when relators did not identify who submitted relevant cost reports and invoices).

Inside the FCA blog

 

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Bass, Berry & Sims' Inside the FCA blog features news, commentary and thought leadership covering FCA, healthcare fraud and procurement fraud.

 

 


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