Tag archives: false claims act

DOJ Recovers More than $2.6 Billion from Health Care False Claims Act Cases in FY 2019

By Keith M. Rosen (US) and Chandra Westergaard (US) on January 21, 2020 Posted in Enforcement, General

On January 9, the United States Department of Justice (“DOJ”) announced its statistics on federal False Claims Act cases for FY 2019. In a lengthy press release, the DOJ reported more than $3 billion in settlements and judgments from civil cases involving fraud and false claims against the government. Of this total, the DOJ reported … Continue reading

The Supreme Court resolves circuit split on FCA statute of limitations period

By Maxwell Karasek (US), Carol Poindexter (US) and Zach Smith (US) on May 14, 2019 Posted in Enforcement

On May 13, the U.S. Supreme Court unanimously affirmed a decision by the U.S. Court of Appeals for the 11th Circuit, holding that the False Claims Act’s (“FCA”) limitations period in 31 U.S.C.(b)(2) applies to “relator-initiated actions” in which the Government declines to intervene and that a relator in a nonintervened suit is not “the … Continue reading

OIG publishes Medicaid Fraud Control Units Fiscal Year 2018 Annual Report

By Savannah Wiseman (US) on March 27, 2019 Posted in Enforcement

On March 25, 2019, the Office of Inspector General (OIG) published its Medicaid Fraud Control Units Fiscal Year 2018 Annual Report. Forty-nine states and the District of Columbia have a Medicaid Fraud Control Unit (MFCU) which is responsible for investigating and prosecuting Medicaid provider fraud and patient neglect and abuse. The report notes that it … Continue reading

Deregulatory wave prompts renewed examination of Stark Law application

By Debbi Johnstone (US), Joseph Keillor (US) and Sarah Jean Kilker (US) on February 2, 2018 Posted in Regulatory

In another sign that the Trump administration’s penchant for regulatory flexibility may apply to the federal fraud-and-abuse regulatory regimes, CMS administrator Seema Verma announced during an AHA Town Hall webcast on January 17 that CMS is convening an interagency group to examine possible ways to minimize the regulatory barriers of fraud-and-abuse laws, including the Stark … Continue reading

Rumors of sea change in DOJ policy potentially confirmed by two recent memos

By Carol Poindexter (US) on January 31, 2018 Posted in Enforcement

Rumors of a significant shift in U.S. Department of Justice (DOJ) policy were confirmed last week when a privileged and confidential internal DOJ memo was leaked to the press. The memo outlines seven factors government attorneys should use for evaluating whether the government should seek dismissal of qui tam actions filed under the federal False Claims … Continue reading

New tax law may have significant consequences for defendants settling False Claims Act suits

By on January 31, 2018 Posted in Enforcement

The Tax Cuts and Jobs Act may significantly limit the deductibility of False Claims Act settlements for defendants going forward. … Continue reading

Relator’s pharmacy allegations dismissed; government’s U&C allegations survive

By on January 30, 2018 Posted in Enforcement

Although a Florida compounding pharmacy has scored a win against a whistleblower’s allegations, it continues to defend against the government’s allegations of improper inflation of its Usual & Customary charges submitted to TRICARE. The U.S. District Court for the Middle District of Florida granted motions to dismiss with prejudice in favor of the pharmacy RS … Continue reading

Court applies Escobar, overturns $350M False Claims Act verdict

By on January 16, 2018 Posted in Enforcement

In Universal Health Services v. U.S. ex rel Escobar, the United States Supreme Court emphasized the importance of the materiality standard in False Claims Act cases. Since that decision, litigants have anxiously awaited further guidance on how Escobar’s instructions would be applied by lower courts. In U.S. ex rel Ruckh v. Salus Rehabilitation, LLC et … Continue reading

Third and Fifth circuits accept materiality arguments in throwing out qui tam cases

By on November 27, 2017 Posted in Enforcement

On November 16, 2017, the Third Circuit Court of Appeals affirmed the grant of summary judgment in favor of CVS Caremark, Corp. (“CVS Caremark”), finding that although the lower court’s reasoning was flawed, the whistleblower Anthony Spay failed to establish the requisite materiality element of a False Claims Act (“FCA”) lawsuit. In making its decision, … Continue reading

DOJ policy shift in qui tam litigation?

By Callan Edquist (US) on November 17, 2017 Posted in Enforcement

Last week, a senior US Department of Justice official appeared to announce a surprising, and potentially significant, shift in policy regarding qui tam litigation. Michael Granston, director of the commercial litigation branch of the fraud section in the DOJ’s civil division, said during a speech that the DOJ will be moving to dismiss False Claims … Continue reading

US Senate returns from recess with Senate Republicans hoping to draft their version of health care reform legislation; members urge HHS to allow charitable assistance programs to provide financial assistance to patients

By Thomas Dowdell (US) on June 5, 2017 Posted in News from DC

The US Senate resumes business this week after a week-long recess with Senate Republicans hoping to begin to draft their version of health care reform legislation. Senate Majority Leader Mitch McConnell (R-Ky.) has expressed doubt whether Republicans will have the minimum 50 votes necessary in the Senate to pass the bill. The most significant issues … Continue reading

Fourth circuit declines to rule on the appropriateness of statistical sampling in FCA cases

By Carol Poindexter (US) on February 15, 2017 Posted in Enforcement

As expected after oral arguments, the Fourth Circuit Court of Appeals declined to decide whether parties may use statistical sampling to prove False Claims Act liability in United States ex rel. Michaels v. Agape Senior Community, Inc., Nos. 15-2145 and 15-2147, by finding that the issue was fact-driven and thus not appropriate for interlocutory review. … Continue reading

DOJ recovers $4.7 billion in 2016, third highest in FCA history

By Michael Koon (US) on December 15, 2016 Posted in Enforcement

The Department of Justice (“DOJ”) announced yesterday that it recovered over $4.7 billion in fiscal year 2016 in civil cases involving claims of fraud against the government under the False Claims Act (“FCA”). This is the third largest annual recovery in FCA history and one of the largest in recent years, easily surpassing last year’s … Continue reading

First and Fourth Circuit Courts of Appeal hear oral arguments in two key FCA cases

By on November 2, 2016 Posted in Enforcement

Last week, the Fourth Circuit and First Circuit heard oral argument in two separate cases dealing with key False Claims Act (“FCA”) issues. First, the Fourth Circuit Court of Appeals heard oral arguments for the interlocutory appeal in United States ex rel. Michaels v. Agape Senior Community Inc., Nos. 15-2145 and 15-2147. Second, in the … Continue reading

Physicians’ compensation structure results in $17M Stark Law fine and CIA for hospital

By on August 2, 2016 Posted in Enforcement

Lexington Medical Center (“LMC”), a 428-bed hospital in South Carolina, has agreed to pay $17 million to resolve allegations that it violated the federal False Claims Act (“FCA”), 31 U.S.C. §§ 3729 et seq., and Physician Self-Referral Law (“Stark Law”), 42 U.S.C. § 1395nn, by allegedly providing improper financial incentives to 28 physicians for referrals.… Continue reading

Legal Update: DOJ announces near doubling of FCA penalties

By on July 1, 2016 Posted in Enforcement

The DOJ has confirmed that the amount of False Claims Act civil penalties is set to nearly double following recent updates to FCA regulations. … Continue reading

SCOTUS endorses “implied certification” FCA claims

By Justin Tschoepe (US) on June 17, 2016 Posted in Enforcement

In a closely watched decision, the U.S. Supreme Court has unanimously endorsed a version of the “implied false certification” theory of liability under the False Claims Act (“FCA”). In a decision that leaves almost as many questions unanswered as it resolved, the Court held that a material omission on a claim for payment may give … Continue reading

OIG reports gain in expected recoveries for fraud and abuse matters

By on June 2, 2016 Posted in Enforcement

On Tuesday, the OIG released its Semiannual Report to Congress, which stated that expected recoveries for fraud and abuse activities total $2.77 billion in the first half of fiscal year 2016. This represents a gain of almost $1 billion when compared to the first half of fiscal year 2015. The report, which covers the time … Continue reading

FCA civil penalties to increase substantially under proposed rule

By Carol Poindexter (US) and Michael Koon (US) on May 5, 2016 Posted in Enforcement

Earlier this week, the Railroad Retirement Board (RRB) became the first federal agency to promulgate an interim final rule implementing provisions of the Bipartisan Budget Act of 2015 intended to index civil penalties assessed under certain statutes to inflation. The RRB’s proposed final rule would double civil penalties assessed under the False Claims Act (FCA). … Continue reading

Fifth Circuit upholds limits on attorneys’ fees in FCA whistleblower suit

By on May 4, 2016 Posted in Enforcement

A decision by the Fifth Circuit Court of Appeals may help FCA defendants challenge relators’ claims for attorneys’ fees, especially where relators’ counsel fails to keep adequate time records distinguishing between work for which the relators recovered an award and work where they did not.… Continue reading

Supreme Court hears arguments on “implied certification” FCA liability

By on April 20, 2016 Posted in Enforcement

On Tuesday, the U.S. Supreme Court appeared reluctant to embrace the government’s expansive view of liability under the False Claims Act (“FCA”), as it heard oral arguments in what may prove to be one of the most significant FCA cases in decades. While it is always hazardous to draw conclusions from questions at oral argument, … Continue reading

DOJ announces new regional elder justice task forces to target nursing home fraud

By on March 31, 2016 Posted in Enforcement

Yesterday, the Department of Justice launched 10 regional task forces aimed at identifying fraud at nursing homes that provide inferior care to elderly residents. Referred to as the Elder Justice Task Forces, the DOJ plans to launch the 10 regional task forces in the following districts across the country:… Continue reading

Supreme Court approves statistical sampling in class action

By Savannah Wiseman (US) on March 28, 2016 Posted in Enforcement

Last week, in a 6-2 decision, the U.S. Supreme Court approved the district court’s consideration of statistical sampling evidence to certify an overtime class action brought under the Fair Labor Standards Act (FLSA) in Tyson Foods, Inc. v. Bouaphakeo.… Continue reading

CMS issues anticipated Medicare overpayments final rule; relaxes initial proposals

By Thomas Dowdell (US), Carol Poindexter (US) and Mark Faccenda (US) on February 12, 2016 Posted in Regulatory

On February 11, 2016, CMS issued a final rule clarifying the requirement of § 1128J(d) of the Social Security Act (created by § 6402(d) of the Affordable Care Act) that health care providers must report and return overpayments within 60 days of the date when they have identified the overpayment or the date any applicable … Continue reading