Melissa L. Jampol, a Member of the Firm in the Health Care and Life Sciences and Litigation practices, in the firm’s New York office, was quoted in the Bloomberg BNA Health Care Daily Report, in “Health-Care Attorneys Eyeing Medicare Fraud and Materiality Cases in 2018,” by Eric Topor. (Read the full version – subscription required.)

Following is an excerpt:

Health-care fraud attorneys are looking to federal courts for guidance in 2018 on several legal theories that have been the subject of numerous False Claims Act lawsuits and lower court rulings in recent years.

Chief among these will be the question of whether lack of medical necessity can form the basis of FCA lawsuits, and the extent of FCA liability faced by Medicare Advantage (MA) providers, an issue being examined in a Department of Justice lawsuit against UnitedHealth Group.

Attorneys will be fixated on how a federal appeals court will rule in an FCA case against a hospice company accused of billing Medicare for improper claims. The DOJ suffered a critical blow when a federal district court ruled that a medical expert’s disagreement with the clinical judgment used to certify a hospice patient’s eligibility can’t prove falsity “as a matter of law” without some additional “objective evidence of falsity.” …

FCA cases premised on off-label marketing allegations will continue to surface in general, Melissa L. Jampol, a member of Epstein Becker & Green’s health-care practice in New York, told Bloomberg Law.Jampol expected whistle-blowers and the DOJ to continue to pursue these cases “despite numerous losses,” including recent wins for Bristol-Myers Squibb in the Sixth Circuit and Solvay Pharmaceuticals in the Fifth Circuit.

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