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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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Seventh Circuit Sidesteps Escobar; Boots FCA Claims for Lack of Knowledge

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July 14, 2016

The Seventh Circuit's rejection of the implied certification theory of liability gave rise, in part, to the circuit split resolved by the Supreme Court's opinion in Escobar. In its first FCA decision since the Supreme Court's opinion - U.S. ex rel. Sheet Metal Workers International Association v. Horning Investments, LLC, the Seventh Circuit sidestepped the question of whether the relator's allegations that a government contractor's certification of compliance with the Davis-Bacon Act amounted to an implied false certification sufficient to give rise to FCA liability. Rather than tackle the implications of Escobar, the Seventh Circuit affirmed entry of summary judgment in favor of the contractor, explaining that the defendant's conduct amounted to certifying compliance with an ambiguous statutory obligation and, therefore, did not constitute a "knowing" violation of the FCA. 

In Horning, the relator asserted FCA claims against a subcontractor on a construction project for the U.S. Department of Veterans Affairs (VA) for allegedly violating the Davis-Bacon Act by failing to compensate workers at prevailing wages. According to the relator, Horning failed to pay workers prevailing wages because it deducted a $5.00 per hour flat fee from the paychecks of each of its employees and placed those funds in an insurance trust without regard to whether an employee was presently eligible for any benefits and without evaluating the actual monetary value of the benefit for each individual employee. Horning allegedly violated the FCA by certifying compliance with the Davis-Bacon Act in connection with its request for payment from the VA.

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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