CMS proposes new “incident to” rule

“Incident to” billing is a significant False Claims Act risk for Medicare and Medicaid providers. A new proposed rule will change how physicians and physician practices are supposed to bill for services provided in their offices. CMS Proposal to Limit Incident to Billing This week CMS released the proposed Medicare... Continue Reading →

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Materiality and Government Knowledge in the Sixth Circuit

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Written by David B. Honig and┬áSteven H. Pratt. On February 2,┬áthe Sixth Circuit Court of Appeals ruled on a case from the Southern District of Ohio, US ex rel American Systems Consulting, Inc. v Mantech Advanced Systems International. At issue was whether a court may determine whether a knowingly false... Continue Reading →

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Seventh Circuit Rejects Novel Fraud Theory

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Relator Thulin was a pharmacist in Idaho working for Shopko, a Wisconsin company. He filed an FCA claim alleging Shopko defrauded Medicaid by failing to pass along private insurance plan prices to Medicaid for dual-eligible patients. The court rejected Shopko’s claim, affirming the trial court’s grant of a motion to... Continue Reading →

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