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No Private Right to Recoup Funds Based on Corporate Practice of Medicine Violation

The United States District Court for the Western District of Washington ruled recently that the state’s corporate practice of medicine doctrine does not provide a private right of action, either express or implied, and...more

Ninth Circuit Holds That Provider Cannot Sue Nonsignatory Insurer for Breach of Contract

On October 10, 2014, the Ninth Circuit affirmed a grant of summary judgment in favor of Manatt client The MEGA Life and Health Insurance Company. In an unpublished memorandum opinion, the Ninth Circuit held that a health care...more

Hospital’s Extortion & Fraud Too Quick to Violate RICO

Danielle Bennion and her co-plaintiffs filed a RICO (Racketeer Influenced & Corrupt Practices Act) action alleging that Mountain View Hospital and co-defendants engaged in a plan of extortion and wire fraud for the purpose of...more

Summer Fraud and Abuse Roundup

The federal government was busy over the summer when it came to decisions and settlements under the Stark Law, anti-kickback law and federal False Claims Act. This article revisits recent developments with respect to...more

Insider Trading Gets Political: Trading on Political Intelligence

Some things are better left unsaid. Especially, it seems, when they involve political intelligence shared by a congressional aide with a lobbyist linked to a political intelligence firm serving Wall Street traders....more

Sixth Circuit Addresses Plan Assets and Limitations Issues in Holding Service Provider’s Fee Assessments Constituted Self-Dealing

The Sixth Circuit held in Hi-Lex Controls, Inc. v. Blue Cross and Blue Shield of Michigan that a service provider was liable as a fiduciary under ERISA for unauthorized fees it assessed against a self-funded health plan. In...more

Anti-Kickback and Stark Law Violations Form Basis for Unfair Competition Claims

On June 16, 2014, a federal district court jury in Florida awarded $14.755 million to plaintiff Ameritox, Ltd., a Maryland-based clinical lab, for state law claims alleging tortious interference with business relationships...more

Alabama Confirms Arbitrators’ Grant of Judgment As A Matter of Law

Just as SCOTUS held its nose and confirmed an arbitration award it thought stunk in Sutter, the Supreme Court of Alabama has confirmed an arbitration award made after only the claimant presented evidence and grounded in a...more

Third Circuit Adopts Relaxed Pleading Standard for False Claims Act Cases

The United States Court of Appeals for the Third Circuit recently rejected the strict approach taken by many federal circuit courts to Federal Rule of Civil Procedure 9(b) that requires a qui tam relator bringing a False...more

Questioning The Caremark Standard

The Justice Department’s aggressive enforcement program has had a profound impact on corporate governance. As a consequence, the last there has been a significant change in emphasis in the C-Suite, among general counsel and...more

Third Circuit Adopts Less Demanding FCA Pleading Standard

Last week, the Third Circuit reversed a New Jersey district court’s decision to dismiss a False Claims Act (FCA) qui tam law suit, holding that the court applied an overly demanding pleading standard to relator Thomas...more

Federal and California State FCA Claims Against NEMS Survive Summary Judgment

On May 13, 2014, a California federal court substantially denied summary judgment motions in United States ex rel. Trinh (No. 4:10-cv-01904 [consolidating Nos. C 10-1904 CW, C 12-2895 CW, C 10-2433 CW, C 10-4605 CW] [N.D....more

Pejorative Statements by Former Patient are not Defamatory, but Protected Opinion

It is fair to say that doctors trade on their reputations more so than most other professionals. When one relies on the doctor to ensure his or her health, and occasionally save a life, the import of such a choice often...more

Two Federal Circuits Find Health Insurance Claims Outside Scope Of Arbitration Clauses

Because courts apply a presumption of arbitrability when they analyze whether particular claims fall within the scope of an arbitration clause, and arbitration clauses are generally drafted very broadly, I don’t usually get...more

Important Court Decision For No-Fault Insurers; Second Circuit Court Of Appeals Rejects Limitation On State Farm v. Mallela

We are pleased to inform you that our firm, together with our co-counsel Bob Stern of Stern & Montana, obtained a very favorable and significant decision for no-fault insurers on an issue of first impression at the appellate...more

Going Public? After Omnicare, You May Want to Keep Your Opinions to Yourself

The Supreme Court has granted certiorari in Omnicare, Inc. v. The Laborers District Council Construction, No. 13-435, and will consider whether a statement of opinion in a Registration Statement must be both objectively and...more

Top franchise cases of 2013

1. In Hanley v. Doctors Express Franchising, LLC, a former franchisee of the Doctors Express franchise system sued Doctors Express, the franchisor, and Rhino 7, a broker involved in the franchise sale, asserting that the...more

$1.2 Billion Medicaid Fraud Penalty Award Reversed and Claim Dismissed in Arkansas Appeal

In another decision narrowing the scope of state Medicaid fraud statutes, on March 20, 2014, the Supreme Court of Arkansas, in Ortho-McNeil-Janssen Pharmaceuticals, Inc. v. State of Arkansas, No. CV-12-1058, unanimously...more

U.S. District Court Grants in Part, Denies in Part Halifax Hospital’s Summary Judgment for Relator’s Non-Intervened FCA Claims

On January 8th, a United States District Court in the Middle District of Florida granted in part, denied in part summary judgment in favor of Halifax Hospital Medical Center and certain other defendants (collectively, Halifax...more

Eighth Circuit Addresses Scope of False Claims Act Liability

Last month, the Eighth Circuit Court of Appeals addressed the scope of “fraud-in-the-inducement” liability under the False Claims Act (FCA), 31 U.S.C. §§ 3729-3733, and, in doing so, reversed the dismissal of a claim related...more

Supreme Court May Decide Issue of the Level of Specificity Required Under Rule 9(b) in FCA Whistleblower Suits

The United States Supreme Court recently indicated its potential interest in hearing arguments in a key False Claims Act (FCA) case that would address a circuit split over the important issue of the level of specificity of...more

Drug Manufacturer’s Liability Under Insurance Frauds Prevention Act May Not Be Inferred From Alleged Kickbacks to Physicians

Three former employees of Bristol Myers Squibb, Inc. (BMS) brought a qui tam action alleging that BMS violated California’s Insurance Frauds Prevention Act, California Insurance Code section 1871.7 et seq. (IFPA), by giving...more

Kurwa v. Kislinger: California Supreme Court Holds No End-Run Around the "One Final Judgment Rule" By Means of Voluntary...

Under California's "one final judgment rule," a judgment that fails to dispose of all the causes of action pending between the parties is generally not appealable. (Code Civ. Proc., § 904.1, subd. (a); Morehart v. County of...more

Matria Healthcare Insider Traders Will Go to Trial

The US District Court for the Northern District of Georgia denied a motion for partial summary judgment in the Security and Exchange Commission’s insider trading case against Earl Arrowood and Parker Petit. The SEC alleges...more

Seventh Circuit: Insurer Was Proper Defendant to an ERISA Benefits Claim, but Setting High Co-Payment Not a Fiduciary Act or De...

In Larson v. United Healthcare Ins. Co., __ F.3d __, 2013 WL 3836236 (7th Cir. 2013), the Seventh Circuit upheld the dismissal of plaintiffs’ putative class action claims that health insurers violated Wisconsin state law...more

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