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CMS clarifies Sequestration does not mandate cuts in Medicare advantage and prescription drug benefit payments to contracted providers, suppliers, and pharmacies

USA - May 3 2013 After several months of confusion surrounding the effect of Sequestration on payment rates under Medicare Advantage Plans (MA Plans) and Prescription...

David S. Greenberg.

Intermountain Healthcare settlement of $25.5 million stems from Stark Law violations

USA - April 8 2013 On April 3, 2013, the Department of Justice (DOJ) announced a settlement with Intermountain Healthcare (Intermountain) 44 months after Intermountain...

Linda A. Baumann, Ritu Kaur Cooper.

Fiscal cliff legislation expands potential overpayment liability

USA - January 10 2013 In a largely unnoticed provision attached to the so-called fiscal cliff bill, Section 638 of the American Taxpayer Relief Act of 2012 ("the Act") adds two...

Amy J. Demske, Linda A. Baumann, Samuel C. Cohen.

Federal courts reject violations of DME supplier standards as basis for False Claims Act liability

USA - November 7 2012 In recent years, the US Department of Justice (DOJ) has used alleged violations of Medicare’s DME Supplier Standards as grounds for prosecuting False Claims Act suits against DME suppliers...

David S. Greenberg.

New York district court rejects quality-of-care false certification theory premised on non-compliance with ESRD conditions of coverage

USA - March 11 2011 In January, the US District Court for the Northern District of New York dismissed a False Claims Act (FCA) case brought by a whistleblower against Dialysis Clinic Inc. (DCI)....