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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.

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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....