Bass, Berry & Sims attorney Taylor Chenery discussed the implications of a recent court ruling demonstrating how a court should analyze multiple different types of alleged claims under the False Claim Act at the motion to dismiss phase of the case. The case involves Boston Heart Diagnostics Corp., who is facing allegations from a former board member that the company paid illegal kickbacks for lab test referrals.

“The court here really confirms that a complaint has to specifically plead knowledge with respect to each alleged fraud scheme or theory of liability,” said Taylor.

The full article, “Boston Heart Lab Group Stuck in Medicare Fraud Case,” was published by Bloomberg Law on September 13, 2018, and is available online (subscription required).

Bass, Berry & Sims Healthcare Fraud & Abuse attorney Brian Roark provided a comment to Home Health Care News about the government’s decision not to intervene in the False Claims Act (FCA) case brought against HCR Manor Care’s hospice division, Heartland. In the case, a whistleblower accused Heartland of submitting false claims and statements to Medicare. However, as Brian points out in the article, Heartland isn’t “necessarily out of the woods yet; the government declining to intervene doesn’t mean an FCA case won’t go forward.”

Continue Reading Brian Roark Comments on Government’s Declination to Intervene in Heartland FCA Case

A unanimous panel of the U.S. Court of Appeals for the Eleventh Circuit (Eleventh Circuit) recently affirmed two grants of summary judgment in favor of defendant Lincare, Inc. d/b/a Diabetic Experts of America (collectively, “Diabetic Experts”) by the U.S. District Court for the Southern District of Florida (District Court).  Diabetic Experts provided diabetic supplies to Medicare patients, some of whom had previously ordered medical supplies from Diabetic Experts for chronic obstructive pulmonary disease (COPD).  To promote sales, staff at Diabetic Experts would place calls to individuals who had previously ordered COPD-related equipment regarding a need for diabetic supplies.

Continue Reading Eleventh Circuit Affirms Two Grants of Summary Judgment in Favor of Diabetic Experts

On April 27, 2016, DOJ announced that Pfizer and its subsidiary Wyeth, LLC, agreed to pay $784.6 million to resolve allegations that Wyeth failed to disclose to federal and state healthcare programs discounts provided to hospitals for Proton Pump Inhibitors (PPIs), as required by its Medicaid Drug Rebate Agreement. DOJ alleged that this lack of disclosure led to states overpaying millions of dollars in reimbursements for PPIs.

Under Medicaid’s Drug Rebate Program, drug manufacturers must enter into a Medicaid Drug Rebate Agreement with HHS for their prescription drugs to be reimbursed by Medicaid. These agreements require manufacturers to pay rebates for drugs purchased by Medicaid. The amounts of the rebates are based on the Average Manufacturer Price, or the average price paid by wholesalers, and the Best Price, or the lowest price paid by any purchaser. These prices must be reported to CMS on a quarterly basis.

Continue Reading Pharma Companies Pay $784.6 Million to Settle FCA Claims

Matt Curley, John Kelly and Shuchi Parikh authored an article outlining the dangers of data misreporting for Medicare Advantage organizations and Medicare prescription drug plans. The article identifies areas of potential liability to help organizations avoid enforcement activity related to fraud and abuse allegations.

The article, “Data Misreporting Risks for Medicare Advantage and Prescription Drug Plans,” was published by Managed Healthcare Executive and featured online. The article also will be included in the May 2015 print edition.