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When Your Medicare Privileges Are On the Line – Don’t Ignore Emergency Judicial Measures

While always a gamble, when a provider is faced with the prospect of losing their Medicare privileges based on allegations of fraud, waste or abuse, filing for a Temporary Restraining Order (TRO) against the government to halt termination may pay substantial dividends.  Recently, Frier Levitt was retained by a large laboratory that had received notice from the Centers for Medicare & Medicaid Services (CMS) that its Medicare billing privileges would...

PROVIDER ALERT: Medicare Advantage Organizations Have Been Wrongfully Terminating Physicians with Little to No Notice and Little to No Cause

In recent months, Medicare Advantage Organizations (MA Organizations) across the country have been on a network termination binge – often terminating physicians without sufficient (or sometimes any) notice and opportunity to appeal. These terminations have been effectuated by, among other means, denying physicians' recredentialing applications, with MA Organizations offering very little in the way of legal justification.  The Centers for Medicare and Medicaid Services (CMS) have promulgated regulations specific to...

False Claims Act Defendants Need Not Always Play Defense – Defendants Can Countersue Whistleblowers Under Certain Circumstances

The number of False Claims Act (FCA) whistleblower actions filed has risen steeply in recent years, as the Federal government has stepped up its scrutiny of healthcare provider billing practices and personal injury attorneys have found a profitable new niche in representing provider employees who seek to blow the whistle on their employers as FCA "qui tam" relators. Providers accused of FCA violations should know, however, that they are not without the...

“Reverse” False Claims Act Actions Against Providers Are On the Rise

Delaying the Return of Overpayments to the Government Could Cost You Millions Recent statutory reforms have given rise to a new and increasingly-common form of liability under the False Claims Act (FCA) – so-called "reverse" FCA liability. Specifically, the Fraud Enforcement and Recovery Act of 2009 (FERA) modified the FCA such that it is now a violation of the statute to "knowingly" conceal or avoid repaying an "obligation to pay...

NJ PROVIDER ALERT: New Jersey Office of the Attorney General Takes Hardline and Legally Questionable Stance on the Prescribing of “Subsys”

In an October 17, 2016 "CONSUMER ALERT" issued by the New Jersey Office of the Attorney General (NJOAG), the State warned that "Any physician found prescribing Subsys to patients not qualified for the treatment will be subject to disciplinary action . . . We will not allow patients' lives to be endangered by prescribers who disregard the federal restrictions placed on this drug." A close-reading of the article reveals that the...