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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

GDPR Top 5 Actions You Should Take Now

The EU's General Data Protection Regulation (GDPR) went into effect on May 25th. As most organizations are aware, the GDPR applies not only to EU businesses but also many companies in the U.S. While the deadline is quickly approaching, most organizations are still grappling with the implications of the regulation on their business. Even if your readiness efforts are behind the curve, the GDPR Top 5 Actions You Should Take NOW will help you begin your efforts towards compliance and help mitigate your organization's risk in the short-term.

Click here to download the checklist.

Eighth Circuit Affirms Dismissal of FCA Claims Related to Ambiguous Regulation

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August 19, 2016

On August 12, 2016, the U.S. Court of Appeals for the Eighth Circuit affirmed summary judgment with respect to FCA claims asserted against an anesthesia practice based on the theory that the practice's physicians billed Medicare for anesthesia services without being present in the operating room during the patients' "emergence" from anesthesia. In U.S. ex rel. Donegan v. Anesthesia Associates of Kansas City, PC, the Eight Circuit concluded that the relator failed to establish that the practice acted with the requisite knowledge because the practice's interpretation of the billing regulation at issue was "objectively reasonable."

The relator alleged that the practice improperly billed the government at the "medical direction" level of billing for anesthesia services. Medical direction billing requires that an anesthesiologist satisfy seven different steps, including participating in "the most demanding aspects of anesthesia pain including, if applicable, induction and emergence." The relator alleged that the practice failed to satisfy that step because its anesthesiologists were almost never present during "emergence" since they typically did not see the patient after surgery until the patient was delivered to the Post-Anesthesia Care Unit (PACU) for recovery.  Under even the broadest definition, the relator argued that "emergence" ends when the patient is turned over to the PACU staff.

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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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