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Can a whistleblower successfully allege Medicaid/Medicare fraud if the whistleblower lacked direct access to records related to the alleged fraud? While the appellate circuits are still split on this issue, we look at recent decisions that indicate a possible shift in the Seventh Circuit’s pleading standard. READ MORE
In May 2019, the U.S. Department of Justice issued new guidelines regarding cooperation and remedial efforts with False Claims Act investigations. The guidelines, 4-4.112, detail the credits individuals and entities may receive during investigations. These guidelines do not change an entity’s or individual’s right to not cooperate with a government investigation. READ MORE
Now that False Claims Act liability is no longer predicated on the government’s decision to identify a particular provision as a condition of payment under the Supreme Court's decision in Escobar, it will be important for health care providers to monitor how courts apply this more demanding standard of materiality. READ MORE
The three key requirements that the Final Rule clarified and which all providers participating in Medicare Part A and Part B must know are: (a) when is an overpayment identified by a provider, (b) what is the required lookback period for returning overpayment, and (c) what process must be used to refund an overpayment. READ MORE
With the continued focus of the government on investigating and prosecuting matters involving compliance with the Stark Law, health care systems entering into compensation arrangements with referring physicians must have robust processes in place to ensure that the compensation arrangements – at the time that they are structured and during the course of the arrangement – don’t run afoul of the Stark Law. READ MORE
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