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Ambiguity Remains After Escobar

Client Alert | 1 min read | 11.09.16

In U.S. ex rel. Nelson v. Sanford-Brown Ltd. (Oct. 24, 2016), the Seventh Circuit, applying the materiality standard articulated by the Supreme Court in Escobar (discussion available here), held that the relator’s allegations that the college inflated grades and job placement figures and paid bonuses to employees for recruitment to fraudulently obtain federal student aid money failed because there was no evidence that the college had made any express or implied representations with its claims for payment or evidence that the government’s payment decision would likely have been different had it known of the alleged misrepresentations. In contrast, the Eighth Circuit in U.S. ex rel. Miller v. Weston Educ. Inc. (Oct. 19, 2016) held that similar allegations withstood summary judgment (as noted by C&M here), suggesting that the Supreme Court’s decision in Escobar may not have resolved the circuit split on implied certification after all.

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Client Alert | 7 min read | 01.30.26

CMS Proposes CY 2027 Growth Rate and Changes to Risk Adjustment for Medicare Parts C and D

On January 26, 2026, the Centers for Medicare and Medicaid Services (CMS) circulated the Calendar Year (CY) 2027 Advance Notice to communicate proposed changes to Medicare Advantage (MA) capitation rates and Parts C and D payment policies.  The changes are expected to be finalized in April 2026 but may be delayed. The following is a summary of the most significant proposals, with further details below:...