7th Circuit Rules “Usual and Customary Pricing” Can Include Discount Programs

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A recent whistleblower case could have a significant impact on Medicare Part D charge limits and corresponding reimbursement and could have ripple effects for aspects of other Medicare programs. The Seventh Circuit Court of Appeals ruled that reduced prescription prices offered by a large retail pharmacy (here Kmart) to participants enrolled... Continue Reading →

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Sixth Circuit Rejects HITECH FCA Complaint

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The Sixth Circuit Court of Appeals, in US ex rel. Sheldon v. Kettering Health Network, affirmed the dismissal of a False Claims Act (“FCA”) suit alleging fraud based upon certifications of compliance with the HITECH Act and a data breach. The HITECH Act, or Health Information Technology for Economic and Clinical... Continue Reading →

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Fourth Circuit Addresses Expanded Definition of “Original Source”

In 2010, the False Claims Act (“FCA”) was extensively amended to limit the public disclosure bar and to expand the ability of whistleblowers to qualify as “original sources” in qui tam litigation. This month, the Fourth Circuit Court of Appeals took an in-depth look at both provisions, in the case US ex... Continue Reading →

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60-Day Overpayment Rule Released

CMS has released its final 60-Day Overpayment Rule, providing clarity to the 2010 Affordable Care Act (“ACA”) amendment to the False Claims Act (“FCA”) that created FCA liability for failure to repay identified overpayment within 60 days. This is a long-awaited rule that provides essential clarity to an amendment that,... Continue Reading →

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“I refute it thus.” The FCA and “Valueless” Damages Claims

Some court decisions are so marvelous, so great at cutting through all the legal argument and theoretical absurdity, that they deserve to be quoted at length. On February 4, 2016, the Hon. Raymond M. Kethledge of the Sixth Circuit Court of Appeals wrote just such an opinion. What follows is the first... Continue Reading →

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Katherine A. Kuchan, R.N., J.D.

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Katherine A. Kuchan, R.N. Hall, Render, Killian, Heath & Lyman, P.C. 111 East Kilbourn Avenue Suite 1300 Milwaukee, WI 53202 Phone: (414) 721-0479 Fax: (414) 721-0491 Email: kkuchan@hallrender.com vCard: Download vCard Biography Katherine Kuchan, a nurse and Shareholder in the firm, provides legal counsel to hospital systems, individual hospitals, inpatient rehabilitation facilities,... Continue Reading →

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J. Patrick Garcia

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Hall, Render, Killian, Heath & Lyman, P.C. 180 Admiral Cochrane Drive Suite 370 Annapolis, MD 21404 Phone: (443) 951-7043 Email: pgarcia@hallrender.com vCard: Download vCard Biography Patrick Garcia regularly advises clients on regulatory and compliance issues with a particular focus on fraud and abuse laws, including Anti-Kickback, Stark, and False Claims... Continue Reading →

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Benjamin A. Waters

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Hall, Render, Killian, Heath & Lyman, LLP Six Tower Bridge 181 Washington Street, Suite 400 Conshohocken, PA 19428 Phone: (484) 532-5672 Fax: (484) 532-5669 Email: bwaters@hallrender.com vCard: Download vCard Biography Mr. Waters brings unique insight to a client’s FCA litigation decisions based on his background representing relators. He has represented... Continue Reading →

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