Public Disclosure Of "Industry-Wide" Overbilling Practice Bars Qui Tam Suit Based Upon Similar But Undisclosed Fraudulent Transactions
Client Alert | 1 min read | 02.21.06
In United States ex rel. Gear v. Emergency Medical Assocs. of Ill. , the Seventh Circuit took an expansive view of the False Claims Act's ["FCA"] "public disclosure" bar , concluding that media and governmental reports concerning the general type of unlawful scheme alleged in a qui tam complaint sufficed to defeat the court's jurisdiction, even though such reports did not identify the particular defendant or any specific instances of its alleged misconduct. Specifically, the Seventh Circuit held that medical journal articles and a series of Department of Health and Human Services Office of Inspector General audits concerning "industry-wide" Medicare billing abuses in which hospitals sought reimbursement for services provided by residents as if they were licensed attending physicians, were "public disclosures" that barred the relator's complaint involving alleged similar overbilling schemes, despite the fact that the disclosures did not identify the two defendants or their specific fraudulent transactions.
Insights
Client Alert | 2 min read | 02.03.26
CMS Doubles Down on RADV Audit Changes
On January 27, 2026, the Centers for Medicare and Medicaid Services (CMS) released a Health Plan Management System (HPMS) memo that provided a long-awaited update on how the agency plans to approach previously announced Risk Adjustment Data Validation (RADV) audits for Payment Years (PY) 2020-2024. The memo is the agency’s most comprehensive statement on the subject since September 25, 2025, when the Northern District of Texas vacated the 2023 RADV Final Rule. The memo makes clear that, while CMS has made certain operational adjustments in response to concerns expressed by Medicare Advantage Organizations (MAOs), the agency is largely pressing forward with the accelerated audit strategy announced in May 2025.
Client Alert | 2 min read | 02.03.26
Sedona Model Jury Instructions for DTSA: A Step Forward—But Questions Remain
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
Client Alert | 4 min read | 01.30.26
Optimum’s Shot Across the Bow: An Antitrust Challenge to Cooperation Agreements
