On Friday, the US Supreme Court agreed to consider two questions involving the so-called “implied certification theory” under the federal False Claims Act (FCA). First, the Court will consider whether the implied certification theory is ever viable for establishing FCA liability. If it is, the Court will also consider under what circumstances FCA liability may … Continue reading
Biggest year ever for declined qui tams On December 3, 2015, the Department of Justice announced that it had recovered more than US$3.5 billion in settlements and judgments from civil cases involving fraud and false claims against the government in the fiscal year ending Sept. 30. According to DOJ’s press release, “US$1.9 billion came … Continue reading
Facing a $237 million verdict for alleged illegal compensation arrangements with doctors, Tuomey Healthcare System has agreed to settle with the government for $72.4 million. According to the government’s press release, Tuomey will be sold to Palmetto Health, a multi-hospital healthcare system, as part of the settlement. Tuomey must also retain an independent review organization … Continue reading
On Tuesday, the Fourth Circuit Court of Appeals agreed to hear an appeal of a False Claims Act (FCA) case that raises the question of whether statistical sampling and data extrapolation can be used to prove liability without other claim-by-claim proof. The case also presents the question of whether the government has absolute, unreviewable veto … Continue reading
The government has announced that a South Florida hospital district will pay $69.5 million to settle False Claims Act allegations related to financial arrangements with physicians. This case follows the trend of increased scrutiny of physician compensation, both by whistleblowers and by regulators: a trend that may escalate in light of the government’s fraud alert … Continue reading
In the first decision interpreting the 60-day overpayment rule of the False Claims Act (”FCA”), Judge Edgardo Ramos of the Southern District of New York held that an overpayment has been “identified” for purposes of starting the 60-day overpayment refund clock when “a provider has been put on notice of a potential overpayment, rather than … Continue reading
An eleven-judge panel unanimously reversed 23 years of precedent in the Ninth Circuit early last week, making it easier for federal False Claims Act (“FCA”) whistleblowers to survive a challenge based on the statute’s public disclosure bar. While last Tuesday’s decision undoubtedly loosens the requirements for whistleblowers in the Ninth Circuit, it does not dramatically … Continue reading
Tuomey Healthcare System Inc. owes the government $237.4 million after losing its Fourth Circuit appeal of a judgment imposed after a jury found the hospital liable for violations of the Stark self-referral law and the False Claims Act. Tuomey has stated that it would likely need to file for bankruptcy based on the damages imposed in … Continue reading
On Tuesday, the U.S. Supreme Court handed down a ruling addressing two major False Claims Act (FCA) interpretive issues. First, the Court held that the Wartime Suspension of Limitations Act’s (WSLA) tolling of the statutes of limitations on claims involving fraud against the government during wartime does not apply to civil fraud cases. Second, the … Continue reading
Another federal court has accepted a whistleblower’s proposal to use a statistical approach in False Claims Act (FCA) litigation to extrapolate from a small billing sample to a much larger universe of claims. This is one of several federal courts to accept this alternative method of establishing liability under the FCA, which could pave the … Continue reading
Today, HHS announced goals and a timeline to move the Medicare program toward paying for the quality – not quantity – of healthcare provided to patients. Although HHS anticipates “better, smarter, healthier” results, this move could give whistleblowers ammunition to bring quality-of-care and worthless-services lawsuits under the False Claims Act. FCA claims are often tested … Continue reading
The possible introduction of a United States-type False Claims Act (FCA) in Australia will see a sharp increase in allegations of fraudulent conduct in many industries, particularly for those in the pharmaceutical industry. The cost of fraud to the public purse arising from fraud is well documented. Many of the large-scale cases of fraud successfully … Continue reading
In FY 2014, for the fifth consecutive year, the Department of Justice (“DOJ”) recovered more than US$2 billion from healthcare entities in False Claims Act (“FCA”) cases. The federal government collected a total of US$5.69 billion overall in FCA actions in FY 2014, and US$2.3 billion of that amount was from healthcare-related FCA actions, according … Continue reading
A decision from the Third Circuit this week makes it harder for whistleblowers to qualify as an “original source” under the False Claims Act (FCA). The Third Circuit ruled in United States et al. v. AstraZeneca Pharmaceuticals LP that whistleblowers bringing lawsuits under the FCA must have firsthand knowledge of the alleged fraud in order … Continue reading
Extendicare Health Services Inc. (Extendicare) has agreed to pay $38 million to settle allegations that the company improperly billed Medicare and Medicaid for “worthless services” in violation of the False Claims Act. According to a press release from the Department of Justice, this is its largest “failure of care” settlement. Although federal courts have held … Continue reading
An appeals court has stricken a $9 million False Claims Act (FCA) verdict for alleged nursing-home neglect, weakening the availability of the “worthless-services” theory as a basis for seeking treble damages against healthcare providers. Momence Meadows Nursing Center, Inc. appealed a jury verdict in a qui tam case brought by two nurses who alleged quality issues relating … Continue reading
In what is being touted as an unprecedented attempt at transparency, Medicare released millions of physician reimbursement records on April 9, 2014. According to the Center for Medicare and Medicaid Services (“CMS”), the data has been released “as part of the Obama Administration’s efforts to make our healthcare system more transparent, affordable, and accountable.” The … Continue reading
Those hoping that the Supreme Court would weigh in on and perhaps resolve the split in the US courts of appeals that currently exists regarding the pleading requirements of 9(b) in the context of False Claims Actqui tam complaints will have to keep waiting. On March 31 the Supreme court denied certiorari in US ex rel. Nathan … Continue reading
The Department of Justice (“DOJ”) announced that it received $3.8 billion in settlements and judgments from civil cases involving fraud against the government in the fiscal year ending September 30, 2013. According to the DOJ, the largest recoveries were related to healthcare fraud: a total of $2.6 billion. The total recoveries under the False Claims … Continue reading