Sixth Circuit Recognizes Exception to Heightened Standard for Pleading False Claim
Client Alert | less than 1 min read | 10.12.16
In U.S. ex rel. Prather v. Brookdale Senior Living Communities Inc. (Sept. 30, 2016), the Sixth Circuit held that a relator pled the “presentment” element even though the relator did not allege information regarding the submission of a specific request for payment. The court reasoned that, in the majority of cases, plaintiffs would need to plead representative false claims but that a relator could survive a motion to dismiss by pleading specific facts based on personal, billing-related knowledge that support a strong inference that specific false claims were submitted for payment.
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Client Alert | 8 min read | 04.17.26
CMS Finalizes CY 2027 Medicare Advantage and Part D Rule: Key Implications for Plan Sponsors
On April 6, 2026, the Centers for Medicare & Medicaid Services (CMS) published its final rule governing the Medicare Advantage (Part C) and Prescription Drug Benefit (Part D) programs for Contract Year (CY) 2027. The final rule is effective June 1, 2026, with most provisions applicable to coverage beginning January 1, 2027, and marketing and communications changes taking effect October 1, 2026. Beyond payment, the rule pursues a broad deregulatory agenda aligned with Executive Order 14192, reversing marketing and enrollment safeguards introduced in 2023 and easing documentation and reporting obligations, while introducing new program integrity requirements.
Client Alert | 1 min read | 04.17.26
Client Alert | 3 min read | 04.17.26
Client Alert | 2 min read | 04.16.26
