News & Analysis as of

Physicians Health Care Providers Appeals

Warner Norcross + Judd

Federal Court Flags Stark and Anti-Kickback Risks in Physician Pay, Spotlights FCA Constitutional Questions on Appeal

On July 28, the federal district court in the Southern District of Ohio issued a pair of orders in related whistleblower cases under the False Claims Act (FCA): United States ex rel. Murphy v. TriHealth, Inc., et al., No....more

Ogletree, Deakins, Nash, Smoak & Stewart,...

Lessons From the Seventh Circuit on Relying on FMLA Certifications and Requiring the Use of Paid Leave

A recent May 2025 opinion from the U.S. Court of Appeals for the Seventh Circuit warns employers that they may not be able to rely strictly on a health care provider’s certification under the Family and Medical Leave Act...more

Nossaman LLP

When Are Hospitals on the Hook? Reconciling Elam and Bichai

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Din v. Sutter Valley Hospital (June 10, 2025, C099101, unpublished) puts the spotlight on a dividing line in California law: when can a hospital be liable for actions taken by its medical staff? The case sharpens the contrast...more

Arnall Golden Gregory LLP

Limitations to the Anti-Kickback Statute? Seventh Circuit Reverses Conviction Finding “Aggressive” Marketing Tactics Insufficient...

On April 14, 2025, the United States Court of Appeals for the Seventh Circuit reversed the conviction of the owner of a durable medical equipment (“DME”) distributor, ruling that there was insufficient evidence to support a...more

Cranfill Sumner LLP

Kickbacks and Causation: Supreme Court Could Soon Settle the Question of Anti-Kickback Statute and False Claims Act Causation...

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A decision by the First Circuit Court of Appeals has deepened the legal debate surrounding False Claims Act (FCA) actions based on violations of the Anti-Kickback Statute (AKS). This decision has increased speculation that...more

King & Spalding

Second Circuit Holds No FCA Violation Where Defendant Relied on Favorable OIG Advisory Opinions

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On April 14, 2025, the Second Circuit issued a summary order holding that the relator failed to plead scienter, a necessary element under the Anti-Kickback Statute (AKS) and the False Claims Act (FCA), where the defendant...more

Hanson Bridgett

Peer Review by Licentiates Only: Beware Health Care Service Plans!

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On February 19, 2025, the California Court of Appeal published a decision, Lin v. Board of Directors of PrimeCare Medical Network, Inc., 108 Cal.App.5th 1163, emphasizing California Business and Professions Code’s requirement...more

Quarles & Brady LLP

Legal Marketing Tactics or an Illegal Kickback Scheme? The Seventh Circuit’s Impending Decision on the Expansiveness of the...

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On December 4, the U.S. Court of Appeals for the Seventh Circuit heard oral arguments in USA v. Mark Sorensen, case number 24-1557, and it is now taking under advisement a case that could have widespread effects as to what...more

Cozen O'Connor

Notice of Appeal - A quarterly newsletter reviewing Third Circuit opinions impacting white collar defense lawyers - Fall 2023

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BACKGROUND- A sugar distributor sought to acquire a sugar producer. The district court determined that the relevant product market included distributors as sources of refined sugar, in addition to sugar producers. The...more

Bradley Arant Boult Cummings LLP

30(b)(6) vs. 702 – Is Your Witness a Party or an Expert?

Earnest v. Sanofi U.S. Services et al, U.S. Circuit Court of Appeals for the Fifth Circuit, No. 20-30184 (Feb. 10, 2022) - The plaintiff sued Sanofi U.S. Services, Inc. and Sanofi-Aventis U.S., LLC in the Eastern District...more

Dorsey & Whitney LLP

CMS’ COVID-19 Vaccine Mandate: What Health Care Providers Need to Know

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Last week, the Centers for Medicare and Medicaid Services (CMS) and the Occupational Safety and Health Administration (OSHA) published their much-anticipated rules mandating COVID-19 vaccinations. ...more

Zuckerman Spaeder LLP

[Webinar] A Step-by-Step Strategy for Maximizing Insurance Coverage Under ERISA - July 22nd, 2:00 pm - 3:00 pm ET

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Building on our recent overview presentation “Six Lessons Patients and Providers Need to Know," we invite you to join us as we examine a single medical provider/patient encounter, in order to identify the concrete steps a...more

Bricker Graydon LLP

Court upholds Ohio law criminalizing physician participation in abortions based on Down syndrome

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A federal appeals court issued a decision on April 13, 2021, upholding an Ohio law that prohibits providers from performing abortions based on a fetal diagnosis of Down syndrome, or on the possibility of a diagnosis. ...more

Health Care Compliance Association (HCCA)

Provider Wins $2M Appeal at ALJ Over Modifier 25, Random Sample

Report on Medicare Compliance 30, no. 11 (March 22, 2021) - A cancer center has won its appeal of $2 million in Medicare claim denials in a case about modifier 25 and the extrapolation of an overpayment. Problems with the...more

McGuireWoods LLP

Fifth Circuit Vacates Fraud Conviction after Denying Codefendants’ Appeal

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The U.S. Fifth Circuit recently reversed a former home health agency employee’s conviction and vacated his sentence related to three counts of healthcare fraud and abuse. Jonathan Nora was convicted by the trial court of...more

Fisher Phillips

Independent Contractor vs. Employee: Federal Appeals Court Instructs How to Structure Physician Agreements To Avoid...

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While the use of independent contractors in the healthcare industry has been a longstanding practice, it is now front and center as the gig economy continues to expand across several industries and the preference for...more

K&L Gates LLP

K&L Gates Triage: Michael P. V. BCBS Of Texas

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In this week’s episode, Gary Qualls discusses a recent case decided in the Western District of Louisiana, which highlights how the application of the arbitrary and capricious standard as applied to payor coverage...more

Bass, Berry & Sims PLC

Eighth Circuit Affirms Dismissal of Kickback Case

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On June 25, the U.S. Court of Appeals for the Eighth Circuit affirmed the dismissal with prejudice of a qui tam False Claims Act (FCA) suit alleging certain physician compensation arrangements at Trinity Health violated the...more

Husch Blackwell LLP

Is the Aseracare precedent in jeopardy? Courts Questioning Clinical Judgment Standards

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The 2019 Aseracare Court of Appeals decision was lauded by hospices as appropriate push-back to overly aggressive whistleblowers and government enforcers. Its central holding, that two physicians can reasonably disagree about...more

Husch Blackwell LLP

Is the Aseracare Precedent in Jeopardy? Courts Questioning Clinical Judgment Standards

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The 2019 Aseracare Court of Appeals decision was lauded by hospices as appropriate push-back to overly aggressive whistleblowers and government enforcers. Its central holding, that two physicians can reasonably disagree about...more

Foley & Lardner LLP

AseraCare FCA Ruling Is A Boon For Health Providers

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All hospice providers routinely should assess risk exposure under the False Claims Act — now with the benefit of the U.S. Court of Appeals for the Eleventh Circuit’s long-awaited decision in United States v. AseraCare Inc. ...more

Spilman Thomas & Battle, PLLC

The Dome Report - 2020 West Virginia Legislature Commences, Issue 2

As you know, the 2020 Regular Session of the West Virginia Legislature commenced on January 8. As of this writing, the House has introduced 903 bills, while the Senate has introduced 467. We will be reporting on and tracking...more

Dorsey & Whitney LLP

Escobar in Action: Physician-owners’ fraud claims against hospital defeated in Fifth Circuit appeal for lack of materiality

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Following the passage of the Affordable Care Act (“ACA”), which placed new limits on physician-owned hospitals, St. Luke’s Health System (“System”) took action to change one of its hospital’s ownership structures through a...more

Fox Rothschild LLP

A Vote Flips, But The Law Stays The Same

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We’ve been following the saga of Hamlet H.M.A., LLC v. Hernandez throughout 2019. Last Friday, the Supreme Court finally issued its opinion in the case. Yesterday, Pat blogged on confusion caused by the tie vote in Hamlet. In...more

Fox Rothschild LLP

Full Of Sound And Fury, Signifying….What Exactly?

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A while back, Justice Edmunds wrote a post that did a deep dive into what it means for the state’s jurisprudence when a case is “affirmed without precedential value.” Matt followed that up with discussion of a Business Court...more

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