Profit Seeking Is Not Fraudulent
Client Alert | less than 1 min read | 10.12.12
In United States ex rel. Williams v. Renal Care Group, Inc., the Sixth Circuit found the defendants did not knowingly submit false claims to Medicare when they followed industry practices and sought guidance -- both from outside legal counsel and the government -- on how to follow ambiguous federal regulations, even though the contractors sought to maximize government payments. The court dismissed the idea that contractors "ought to be punished solely for seeking to maximize profits" and rejected the government's argument that the companies had "recklessly" misinterpreted the regulations to do so.
Insights
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
