Legal and practical healthcare information.
The Federal False Claims Act (“FCA”) allows private parties to bring lawsuits in the name of the federal government against defendants who allegedly “knowingly” present a false claim to the government for payment. The question for courts has been what standard should be applied to evaluate a defendant’s “knowledge.” The US Supreme Court recently clarified …
Continue reading “False Claims Act “Knowledge” Is a Subjective Standard”
Originally published in Healthcare Michigan, Volume 40, No. 7 A recent decision by the Supreme Court clarified the required intent for a defendant to be held liable under the False Claims Act. According to the Court, the FCA’s scienter requirement refers to a defendant’s knowledge and subjective beliefs – not what an objectively reasonable person might have known …
The Federal False Claims Act (“FCA”) imposes civil liability for presenting a false claim to the government for payment. The Federal Anti-Kickback Statue (“AKS”) prohibits medical providers from making referrals in return for “remuneration.” In a recent decision by the Sixth Court of Appeals, the Court found that a hospital’s decision not to hire an …
Continue reading “Sixth Circuit Defines False Claims Standards”
Health Canada determined that Texas-based LE-VEL BRANDS, LLC (“Le-Vel”), broke the law by selling its weight loss products to Canadians without seeking product licenses for their natural health products. The products had been distributed in Canada for some time, and Health Canada had flagged no health concerns. In deciding to issue a stop-sale order, Health Canada relied upon …
Continue reading “U.S. Marketing Materials Can and Will Be Used Against You in a Canadian Court”
Last month, we published an article summarizing new surprise billing laws that prohibit nonparticipating providers from balance billing patients when the patient’s insurance company pays less than the provider’s usual and customary charge. The Michigan law, known as the Surprise Medical Billing Law, has been in effect since last year. The Federal law, known as …
Continue reading “Court Strikes Down Portions of Federal Regulations Concerning No Surprises Act”
Dickinson Wright’s Health Care Practice group announces the creation of its Health Care Litigation Task Force. Our Health Care Practice Group is diverse in its representation of clients operating in the health care industry. While a traditional litigation attorney can handle routine matters, when facing complex health care litigation matters you need an attorney who …
In its latest case addressing retiree health benefits, the Sixth Circuit Court of Appeals has held that a collective bargaining agreement’s general durational clause controls when retiree healthcare benefits end. Zino v. Whirlpool Corp., 2019 BL 50961, 6th Cir. (2019). This is a new data point indicating that the Sixth Circuit has moved away from …
Telemedicine is a relatively new concept that allows healthcare providers to treat patients via the Internet through varying technology platforms, such as FaceTime or Skype. While the practice initially started as a means for healthcare providers to treat patients in rural or remote areas who were far away from local health facilities or in areas …
Continue reading “Ohio Expands Telemedicine to Include Teledentistry”
A summary of the article “A Review of Key 2018 False Claims Act Recoveries and Developments,” which first appeared in Physicians Practice. In December, the Department of Justice announced that it recovered more than $2.8 billion in False Claims Act judgments and settlements for fiscal year 2018. The largest settlements involved pharmaceutical companies: AmerisourceBergen Corporation, …
Continue reading “A Review of Key 2018 False Claims Act Recoveries and Developments”
Conflicts between a benefit plan Summary Plan Description and a plan document are an ever-present concern for plan sponsors. An aggrieved participant who relies on SPD language will often pursue a claim for benefits even though he/she is not entitled to the benefit under the plain terms of the plan document. This problem is illustrated …