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State University Hospital Fends Off FCA Claims Under "Arm-of-the-State" Test

Client Alert | 1 min read | 07.16.13

In U.S. ex rel. King v. The University of Texas Health Science Center-Houston, a federal court considered whether The University of Texas Health Science Center–Houston was subject to liability under the qui tam provisions of the federal civil False Claims Act, based on a former employee's allegations that the hospital had defrauded the federal government by covering up misconduct related to federal research grants, and retaliated against the employee for reporting the misconduct. Applying the "arm-of-the-state" test (previously discussed here), the court held that the university hospital was a state entity -- and thus, was not a "person" subject to suit under the FCA -- and likewise held that employee's FCA retaliation claim was barred by sovereign immunity, providing a victory in the latest round of FCA scrutiny impacting higher ed institutions (discussed here and here).


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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:...