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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 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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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

 

To continue reading the content in this article on the firm's Inside the FCA blog, please click here to view the post.

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

 

 


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