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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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FCA Deeper Dive: Meeting the FCA's Intent Requirement

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Publications

March 23, 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 the requirement that a relator plead and prove that a defendant acted with the requisite level of knowledge to establish an FCA claim and evaluate how courts have evaluated this issue in recent cases.

In U.S. ex rel. Saldivar v. Fresenius Medical Care Holdings, Inc., 2015 WL 7293156 (N.D. Ga. Oct. 30, 2015), the district court granted Fresenius's motion for summary judgment, holding that no reasonable jury could find that Fresenius acted "knowingly." The relator alleged that Fresenius violated the FCA by impermissibly billing Medicare for overfill in medication vials. The district court explained—in a 108-page opinion—that the relator could not prove that Fresenius knew its billing for overfills was impermissible or that it acted with deliberate ignorance or reckless disregard as to whether such billing was permissible. The district court focused on whether Fresenius had actual knowledge that it should not seek Medicare reimbursement for overfills. Key to this analysis were the facts that: (1) Fresenius relied on counsel in determining whether to bill Medicare and the law was silent on this issue during the relevant time period; (2) Fresenius and its counsel believed that many companies had billed for overfills and that the government knowingly reimbursed those companies for years; (3) Fresenius was very serious in its efforts to comply with Medicare rules and regulations; and (4) Fresenius had previously disclosed its overfill billing to the government, but was never warned that its actions were improper.

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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