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Expert Analysis

The FCA, Medical Necessity And Gov't Regulation Of Medicine

By Geoffrey Kaiser ( May 12, 2020, 6:19 PM EDT) -- In recent years, much attention has been paid to what makes a claim false under the False Claims Act when the underlying misconduct is based on the alleged lack of medical necessity for the services provided. Bearing on this issue are Court of Appeals decisions from the Third, Sixth, Ninth, Tenth and Eleventh Circuits that have considered whether and under what circumstances a difference in medical opinion can suffice to prove falsity and fraud under federal law....

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