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Beware of Your Medicare Advantage Capitated Arrangements - False Claims Act Exposure Lurks in Your Diagnosis Coding

USA - March 14 2019 The US Department of Justice filed its complaint-in-intervention in the Northern District of California on March 4, 2019 against Sutter Health and...

Friday Enforcement Wrap: Health Care System Settles Stark Law Investigation for $12 Million

USA - December 14 2018 Aurora Health Care, Inc. settled allegations that it violated the False Claims Act by submitting claims to Medicare and Medicaid in violation of the...

D. Jacques Smith, Nadia Patel, Rebecca Wolf, Harsh P. Parikh, Stephanie Trunk, Sean Clerget, Randall A. Brater, Michael F. Dearington.

New CMS Final Rule Gives States Increased Flexibility to Define Essential Health Benefits Despite Disapproval from Patient Advocacy Groups

USA - April 19 2018 In a new final rule released on April 9, 2018, CMS is allowing states substantially more flexibility in selecting Essential Health Benefits...

Rachel E. Yount, Caroline Turner English.

Needing to Adjust: DOJ and HHS Announce Steep Increases to FCA, Stark Law, Anti-Kickback Statute, and EMTALA Penalties

USA - September 13 2016 Life science companies, health care providers, and government contractors will be at risk for significantly larger penalties due to substantial...

D. Jacques Smith, Rachel E. Yount, Randall A. Brater.

Duh, It's Fraud: Supreme Court Says the False Claims Act Isn't That Complicated

USA - June 20 2016 In a highly anticipated decision, the United States Supreme Court issued a unanimous opinion in Universal Services, Inc. v. United States ex rel...

D. Jacques Smith, E. Jon A. Gryskiewicz, Thomas E. Jeffry Jr., Randall A. Brater.