Eastern District of Tennessee Denies Interlocutory Appeal of Order Permitting Sampling to Prove Liability

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In September, the District Court for the Eastern District of Tennessee issued an order denying Defendants’ motions for summary judgment and permitting the government to use statistical sampling to determine liability in a False Claims Act case. The decision – a first in FCA jurisprudence – was immediately the subject of a motion... Continue Reading →

Hospital Improvements for Payment: Opportunity to Comment

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On Wednesday, November 19, the House Ways and Means Subcommittee on Health released draft legislation intended to improve hospital issues in the Medicare system.  The legislation addresses Medicare’s controversial “two-midnight” rule, short inpatient stays, outpatient observation status, the RAC audit program and the appeals process.... Continue Reading →

DOJ Announces that 2014 Sees Record FCA Recoveries and Whistleblower Lawsuits

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Yesterday, November 20, the Department of Justice (“DOJ”) announced that the United States had recovered almost $6 billion from False Claims Act (“FCA”) litigation in 2014 – marking the first time the DOJ has recovered more than $5 billion in a single year. With these recoveries, the DOJ reached several milestones. Not... Continue Reading →

This Week in Washington – November 21, 2014

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Ways and Means Releases Draft Hospital Legislation On Wednesday, November 19, the House Ways and Means Subcommittee on Health released draft legislation intended to improve hospital issues in the Medicare system.  The legislation addresses Medicare’s controversial “two-midnight” rule, short inpatient stays, outpatient observation status, the RAC audit program and the... Continue Reading →


This Week in Washington – November 14, 2014

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Lawmakers Continue Push for SGR Deal in Lame Duck More than 110 members of Congress, including the GOP Doctors Caucus, are urging House leadership to repeal and replace Medicare’s Sustainable Growth Rate (“SGR”) formula for physician payment before Congress adjourns in December. With House Ways and Means Chairman Dave Camp... Continue Reading →

Seventh Circuit Rejects Novel Fraud Theory

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Relator Thulin was a pharmacist in Idaho working for Shopko, a Wisconsin company. He filed an FCA claim alleging Shopko defrauded Medicaid by failing to pass along private insurance plan prices to Medicaid for dual-eligible patients. The court rejected Shopko’s claim, affirming the trial court’s grant of a motion to... Continue Reading →

The Use of Fair Market Value Assessments for Health Care Leasing Arrangements

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Under both the Stark Law and the Anti-Kickback Statute, space lease arrangements between referring physicians and hospitals are coming under growing scrutiny as the government’s concentration on eliminating Medicare and Medicaid fraud and overpayments increases. Safe harbors and exceptions with respect to lease arrangements exist under both statutes with one... Continue Reading →

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