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Recent Changes Impact Appeal of Medicare Denials and Reimbursement Strategies

Recovery Audit Contractors (“RACs”) and other Centers for Medicare and Medicaid Services (CMS) contractors are charged with identifying overpayments made by Medicare to healthcare providers. However, with the increase in RAC...more

Resubmission of Hospital Claims

On February 13, CGS Administrators, the Parts A and B Medicare Administrative Contractor for Kentucky and Ohio, relayed instructions to Medicare hospitals paid under the Inpatient Prospective Payment System from the Centers...more

Payment Matters: No Judicial Review of Contractor’s Finding of a High Payment Error Rate, a Condition for Extrapolation

Before a Medicare contractor can use extrapolation to determine an overpayment amount, the Medicare statute requires that it must make a finding that there is a sustained or high level of payment error or that documented...more

Shell E & P Ireland Ltd v McGrath & ors

Judgement in Shell E & P Ireland Ltd v McGrath & ors

2.1 Shell issued proceedings against the six named defendants on the 4th March, 2005 with a statement of claim being delivered on the 18th April. Damages were sought together with various orders restraining the defendants...more

A Reduction in the Utility of Civil Investigative Demands and the Interpretive Narrowing of "Person" under the False Claims Act

Executive Summary: False Claims Act actions against government contractors are on the rise. But two recent decisions offer potential limitations to false claims exposure, and may aid defendants in future FCA litigation....more

Sending the Privilege Away: Attorney-Client E-Mails in the Corporate Setting

In a pending False Claims Act (“FCA”) case involving allegations of noncompliance with the federal physician self-referral law (the “Stark Law”), 42 U.S.C. § 1395nn, the United States District Court for the Middle District of...more

The False Claims Act and Healthcare Providers: Key Results from 2012 and Likely Trends for 2013

From the perspective of False Claims Act (FCA) results, 2012 was a decidedly mixed year for healthcare providers. The bad news was quite bad—increased FCA scrutiny by the Department of Justice (DOJ) led to $3 billion of...more

Court of Federal Claims Upholds 40% Small Business Subcontracting Goal

In a recent decision, the U.S. Court of Federal Claims denied a pre-award protest challenging a solicitation's small business subcontracting goal of 40% of the total contract value, holding that this goal was within the high...more

Payment Matters: Providers Again Win in Medicare Disproportionate Share Adjustment Challenge

In a 2011 decision, Northeast Hospital Corp. v. Sebelius, 657 F. 3d 1 (D.C. Cir. 2011), the United States Court of Appeals for the District of Columbia Circuit ruled for the providers in a challenge to the Secretary’s...more

Recent Federal False Claims Act Decision Undermines Attorney-Client Privilege over Certain In-House Counsel Emails

A federal magistrate judge's recent decision in United States ex rel. Baklid-Kunz v. Halifax Hospital Medical Center, a Civil False Claims Act (“FCA”) case pending in the United States District Court for the Middle District...more

District Court Rejects Fraud-on-the-FDA Theory of False Claims Act Liability

In an opinion that continues a welcome trend in False Claims Act cases, Judge Saylor of the United States District Court for the District of Massachusetts has dismissed a relator’s FCA complaint for failing to plead facts...more

Statute of Limitations Doesn’t Apply in UConn Law Library Lawsuit, State Supreme Court Rules

The Connecticut Supreme Court recently reversed, in a unanimous published opinion, a trial court's entry of summary judgment in favor of 27 defendants involved in the allegedly defective design and construction of the...more

Sixth Circuit: FERA False Claims Act Amendment Applies Retroactively to Cases Pending as of June 7, 2008

On November 2, 2012, the Sixth Circuit held that a 2009 amendment Congress made to the liability provisions of the False Claims Act ("FCA") applies retroactively to civil FCA cases pending as of June 7, 2008. U.S. ex rel....more

Off the Beaten Path: The Federal Circuit Departs From Precedent in Lumbermens

On August 23, 2011, the Washington, D.C. metropolitan area was surprised and shocked by an earthquake with a magnitude of 5.8, leading to the evacuation and temporary closing of multiple public and private buildings, and...more

Connecticut Supreme Court Reaffirms State's Immunity from Statutes of Limitation

In a decision followed closely by the construction industry, Connecticut's Supreme Court has issued a unanimous decision confirming a long-standing rule that statutes of limitations do not run against the State. The...more

Sixth Circuit Overturns $82.6 Million Medicare Fraud Judgment

Based on the recent decision in United States, ex rel. Williams v. Renal Care Group, Inc., medical service providers in the Sixth Circuit that have established separate corporate entities to maximize corporate profits and...more

U.S. Supreme Court Asked to Review Federal Funding of Human Embryonic Stem Cell Research

On October 10, 2012, two pro-life groups petitioned the U.S. Supreme Court to review and reverse the U.S. Court of Appeals for the District of Columbia Circuit Court’s decision allowing the continued federal funding of...more

Sixth Circuit Rebukes Government’s Reliance on Profit Motive to Prove False Claim

On October 5, 2012, the Sixth Circuit reversed an $82.6 million award in a False Claims Act (FCA) lawsuit against Fresenius Medical Care Holdings (Fresenius) and granted partial summary judgment in favor of the defendants. ...more

Federal Appeals Court Says Estimates in Government Bids Can Be Actionable As False Claims

The Ninth Circuit issued an opinion last week in which it held that knowingly making “false estimates” in connection with a bid for a government contract may be actionable under the False Claims Act (“FCA”), 31 U.S.C. §§3729...more

California Supreme Court Rules that Prevailing Wage Laws Do Not Apply to Charter Cities

In a much anticipated decision, the California Supreme Court ruled on July 2, 2012, that charter cities in California may exempt themselves from state prevailing-wage requirements. In doing so, the Court affirmed the...more

Frito-Lay Appeals ARB Ruling Which Granted OFCCP Access to Data

Frito-Lay Inc. has been involved in litigation with the Office of Federal Contract Compliance Programs (OFCCP) over the agency's ability to obtain data after the date of the compliance review scheduling letter. The Company...more

Health Law Alert: Federal Research Grant Recipients Face False Claims Lawsuit

Many of the high-profile False Claims Act (FCA) cases against the health care industry have involved allegations that false claims for payment were submitted for items or services provided to Medicare or Medicaid...more

The D.C. Circuit Empowers Relators in Qui Tam Actions in United States ex rel. Schweizer v. Océ N.V.

As discussed in the March 2012 edition of the White Collar Watch, the case of United States ex rel. Schweizer v. Océ N.V. highlights the tension between the interests of qui tam relators and the United States Department of...more

Recent Developments May Impact Service-Disabled Veteran-Owned Small Business Verification Processes And Contracting

Over the past few weeks there have been two significant developments that may impact both the U.S. Department of Defense's (DoD) and the U.S. Department of Veterans Affairs' (the "VA") Service-Disabled Veteran-Owned Small...more

Avoiding "Embarrassment" In Contract Disputes Act Litigation: Routine vs. Non-Routine Requests For Payment

Contractors pursuing claims against the government under the Contract Disputes Act (“CDA”) can often fall victim to the jurisdictional pitfalls of the Act from the very start of the claims process, i.e., with the claim...more