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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

Download the Healthcare Fraud & Abuse Review 2017, authored by Bass, Berry & Sims

The Healthcare Fraud & Abuse Review 2017 details all healthcare-related False Claims Act settlements from last year, organized by particular sectors of the healthcare industry. In addition to reviewing all healthcare fraud-related settlements, the Review includes updates on enforcement-related litigation involving the Stark Law and Anti-Kickback Statute, and looks at the continued implications from the government's focus on enforcement efforts involving individual actors in connection with civil and criminal healthcare fraud investigations.

Click here to download the Review.

Seventh Circuit Rejects Specific Claims Requirement for 9(b), Maintains a High Bar for Medical Necessity Allegations

Firm Publication


September 27, 2016

On September 1, 2016, the U.S. Court of Appeals for the Seventh Circuit reversed the dismissal of an FCA lawsuit by the U.S. District Court for the Eastern District of Wisconsin, and in doing so, evaluated the particularity required to survive a motion to dismiss under Rule 9(b) as it relates to both a relator's obligation to plead specific claims and the specifics of the underlying fraudulent conduct at issue.

In U.S. ex rel. Presser v. Acacia Mental Health Clinic, LLC, the relator worked at a mental health clinic as an independent contractor nurse practitioner and alleged that the clinic fraudulently billed for medically unnecessary services. The relator alleged that the FCA violations resulted from four types of conduct: (1) requiring patients to see four clinicians and incur separate charges from each in order to be provided with medications; (2) mandating that the receptionist and medical nurse practitioner use a billing code for full psychological assessment by a therapist or a psychiatric medical evaluation by a psychiatrist or psychiatric nurse practitioner; (3) performing mandatory urine screens for each patient on each visit; and (4) requiring patients to come in to the clinic for refills or to speak with a physician.

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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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