• September 27, 2016

    Rainmaker Q&A: Briggs And Morgan's Michael McEllistrem

    Sometimes you make a real connection with a client, but other times you realize a pitch is not going according to plan. No need to bore a future prospect with the balance of your presentation and brochures — just make a solid connection, thank them for the opportunity and gracefully withdraw, says Michael McEllistrem, a shareholder at Briggs and Morgan PA.

  • September 27, 2016

    BREAKING: FTC Loss On Pa. Hospital Merger Reversed By 3rd Circ.

    The Third Circuit on Tuesday sided with the U.S. Federal Trade Commission and the state of Pennsylvania in a dispute over the merger of two state hospital systems, finding the government demonstrated the combination would likely be anti-competitive and reversing a lower court ruling that blocked the agencies from pausing the merger.

  • September 26, 2016

    Fla. Hospice Provider, Doctors Escape Medicare Fraud Claims

    A Florida federal judge has tossed a suit accusing a hospice care provider and referring medical providers of defrauding Medicare of at least $320 million, finding a whistleblower's claims were not specific enough and failed to amount to violations of the False Claims Act.

  • September 26, 2016

    HHS Health Info Protection Rules, Oversight Are Lacking: GAO

    The U.S. Department of Health and Human Services needs to improve its security and privacy guidance and oversight, the U.S. Government Accountability Office said in a report released Monday, saying the steps the agency has taken to protect health information don’t go far enough.

  • September 26, 2016

    Blue Cross Presses To Trim Michigan Tribe's ERISA Claims

    Blue Cross Blue Shield of Michigan continued to press a federal court Friday to pare down the Little River Band of Ottawa Indians’ suit alleging the insurer mismanaged the tribe’s employee benefit plan under the Employee Retirement Income Security Act, arguing it had no duty to cap health care claims at certain rates.

  • September 26, 2016

    Ambulance Co. 'Upcoding' Suit Dismissed For Lack Of Proof

    Two whistleblowers haven’t sufficiently argued that CareFlite, a Dallas-area nonprofit that provides ambulance services, systemically billed Medicare or Medicaid for more advanced services than it provided, a Texas federal judge said on Monday in dismissing the False Claims Act suit.

  • September 26, 2016

    Docs Treating Opioid Addicts To Report Details To HHS

    Doctors using medication to treat opioid addiction will soon be required to make annual reports about their patient caseloads, according to a U.S. Department of Health and Human Services final rule to be published Tuesday in the Federal Register.

  • September 26, 2016

    New England Health System Fined By HHS Over Data Loss

    Care New England Health System agreed Friday to hand over nearly half a million dollars to the U.S. Department of Health and Human Services to settle potential Health Insurance Portability and Accountability Act privacy and security rule violations, after losing unencrypted backup tapes containing thousands of women's ultrasound studies.

  • September 26, 2016

    Growing FCA Pipeline Provides Justices Plenty To Ponder

    The U.S. Supreme Court has taken an unprecedented number of False Claims Act cases in recent years, and issues posed by numerous pending petitions — as well as those bubbling up in lower courts — will likely result in that trend continuing.

  • September 26, 2016

    NJ High Court To Mull State's Subpoena Power In FCA Action

    The New Jersey Supreme Court said Friday it will review a finding that the state attorney general cannot subpoena two former employees of a pharmacy benefits company targeted in a False Claims Act suit because the deadline had passed for the state to intervene in the case.

  • September 26, 2016

    Kelcy Warren Claims Cancer Center CEO Committed Fraud

    Billionaire energy tycoon Kelcy Warren alleged in a Texas state court suit that the company behind a now-bankrupt planned cancer treatment center in Dallas violated the Texas Securities Act and committed fraud when it solicited a $20 million investment from him.

  • September 26, 2016

    Cerner Says Wash. Has Jurisdiction In $63M UAE Cos. Suit

    Electronic medical records provider Cerner Corp. urged a Washington federal judge on Friday to keep its $63 million lawsuit against a United Arab Emirates businessman alive, saying real estate he indirectly owns in the district gives courts power to hear the dispute.

  • September 26, 2016

    7th Circ. Orders Ill. To Help Find Nurses For Sick Kids

    The Seventh Circuit on Friday ordered the state of Illinois to do something to help chronically ill children seeking in-home nursing care, saying Medicaid required the state to not only pay for the services but also to help locate them.

  • September 26, 2016

    PhRMA Rips Feds For 'Regulation By Litigation' On Kickbacks

    Trade group Pharmaceutical Research and Manufacturers of America has jumped into a closely watched False Claims Act case in Massachusetts federal court by accusing the U.S. Department of Justice of unconstitutionally using “regulation by litigation” to shape anti-kickback policies.

  • September 26, 2016

    Rainmaker Q&A: Dowd Bennett's James Martin

    It’s important to have the right people with you to make a pitch. Too many lawyers try to present themselves as a jack of all trades. Instead, create teams to offer a panel of strengths to the client, says James Martin, a partner at Dowd Bennett LLP.

  • September 23, 2016

    Insurers, Providers Trade Harsh Words On ACA Steering

    Federal regulators are hearing wildly divergent perspectives on improper steering of patients toward and away from Affordable Care Act plans, as insurers allege kickback-style financial assistance and health care providers allege discriminatory practices aimed at low-income Americans, newly released letters show.

  • September 23, 2016

    Pharmacy Head Seeks To End Long-Running Kickback Suit

    The president of a Chicago pharmacy asked an Illinois federal judge on Thursday to dismiss the remaining False Claims Act charges brought by a former employee in a long-running suit claiming the pharmacy forgave copays while still seeking maximum reimbursements from Medicare and Medicaid.

  • September 23, 2016

    Fla. High Court Limits Arbitration In Nursing Home Cases

    The Florida Supreme Court held on Thursday that nursing home residents can’t be bound by arbitration agreements in contracts signed with the home by family members, settling a dispute between several of the state’s appellate courts over the contracts and how they can be applied.

  • September 23, 2016

    Ill. Judge Points Lost-Grant Suit To Fed. Claims Court

    A judge tossed the bulk of an Illinois federal court lawsuit against the Centers for Medicare & Medicaid Services Friday, saying a former grant recipient under an Affordable Care Act program will have to seek monetary compensation in the U.S. Court of Federal Claims instead.

  • September 23, 2016

    EEOC Says Hospital Denied Religious Vaccine Exemptions

    An Erie hospital affiliated with the Allegheny Health Network was sued by the U.S. Equal Employment Opportunity Commission in Pennsylvania federal court Friday, over allegedly firing six employees after it denied their request for a religious exemption from the flu vaccine.

Expert Analysis

  • HHS Small Breach Focus Shows Growing Scope Of HIPAA Probes

    Joanna Bergmann

    Flexing more enforcement muscle, the U.S. Department of Health & Human Services recently announced it will more widely investigate breaches of protected health information affecting fewer than 500 individuals. As a result, health care providers and other covered entities and their business associates should expect an uptick in the volume of enforcement actions triggered by small-scale breaches, say attorneys with Ropes & Gray LLP.

  • You Don’t Need A Data Breach To Face Regulatory Scrutiny

    Kim Peretti

    One side effect of the rise in bug bounty programs, and disclosures by security researchers and others, is a commensurate increase in publicly known security vulnerabilities that can lead to increased scrutiny from regulators and the plaintiffs bar, says Kim Peretti, co-leader of Alston & Bird LLP's cybersecurity preparedness and response team.

  • The Perils Of Parallel FCA Proceedings

    Tony Maida

    Parallel criminal and civil proceedings in False Claims Act cases raise important and troublesome issues for the defense, including protecting the defendant’s Fifth Amendment rights while mounting a robust defense in the civil case. But, as shown in recent decisions from the Eastern District of Kentucky and Southern District of New York, parallel proceedings may also prove challenging to the U.S. Department of Justice, say Tony Mai... (continued)

  • When Ambiguous Regs Preclude FCA Liability

    Taylor Chenery

    The Eighth Circuit’s opinion in U.S. v. Anesthesia Associates is the most recent in a line of cases suggesting that a provider faced with a potentially ambiguous regulation or statute can protect itself from potential False Claims Act liability by taking steps to ensure that its interpretation of the ambiguous provision is reasonable under the circumstances, says Taylor Chenery of Bass Berry & Sims PLC.

  • Practical Uses For Machine Learning In Health Care Cases

    Mihran Yenikomshian

    Machine learning can efficiently turn enormous volumes of both structured and unstructured data into something meaningful, without losing underlying details. Consultants with Analysis Group Inc. elaborate on how machine learning can be applied in the courtroom in terms of informing legal strategy, identifying relevant materials for experts, and enhancing expert testimony in health care litigation.

  • Common Regulatory Pitfalls In Health Care M&A

    Excerpt from Lexis Practice Advisor
    Matthew E. Eisler

    The health care regulatory environment can be complex and difficult to navigate for new entrants into the field and seasoned veterans alike. Depending on the type of transaction, various federal, state, local and agency rules may apply. Matthew Eisler and Russell Hedman of Hogan Lovells US LLP discuss essential steps to identify and address regulatory risk in health care acquisitions.

  • Overhauling Law Firm Records Departments For A New Reality

    Raymond Fashola

    As automation increases, so do business challenges that impact overall law firm operations. Records departments are facing roadblocks associated with antiquated processes, ever-changing regulatory requirements, and emerging technologies. As a result, firms are reassessing the needs of their records department staffing models, says Raymond Fashola of HBR Consulting.

  • Courts Are Taking Materiality Seriously Post-Escobar

    Bradley D. Wine

    Three months after the U.S. Supreme Court's Escobar decision, we can see some trends emerging in False Claims Act decisions that may give contractors a ray of hope, say Bradley Wine and Daniel Chudd of Morrison & Foerster LLP.

  • Counting FCA Penalties: It's All In The Claims

    Adam P. Feinberg

    Last month, the civil penalty range under the False Claims Act nearly doubled. Much of the conversation surrounding this development has focused on the excessive fines clause of the Eighth Amendment and the due process clause. However, it has also placed a renewed focus on the proper method for counting the number of FCA penalties, arguably an even more important issue, say attorneys at Miller & Chevalier Chartered.

  • How CMS Plans To Steady An Unstable ACA Marketplace

    Cynthia J. Borrelli

    In the wake of market instability the Centers for Medicare and Medicaid Services has proposed benefit and payment parameters for 2018 to improve risk pools and make Affordable Care Act exchanges more attractive. However, if not accompanied by other regulatory measures, these provisions would have unintended consequences for the insurance market, says Cynthia Borrelli of Bressler Amery & Ross PC.