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OIG Issues Revised Provider Self-Disclosure Protocol

On April 17, 2013, the Office of Inspector General (OIG) of the United States Department of Health and Human Services (HHS) revised its Provider Self-Disclosure Protocol (SDP), originally published in 1998, and updated in...more

CMS Proposes to Increase Awards for Non-Qui Tam Whistleblowers

CMS wants to change the way that it rewards non-qui tam whistleblowers who report alleged fraudulent or unlawful conduct related to Medicare or Medicaid. Using an IRS program as a model, CMS recently proposed rule changes to...more

Courts of Appeals Continue to Limit the Government’s Aggressive False Claims Act Theories

This spring saw two significant victories for health care providers in the federal courts of appeals. In both cases, the courts rejected an aggressive government theory under the False Claims Act (FCA), the first related to...more

Court of Appeals Rules for Government in DSH Exhausted Benefit Day Appeal

For the last several years, hospitals and the government have fought hard over where days associated with certain “dual eligible” patients should be placed in the Medicare disproportionate share hospital (DSH) calculation. At...more

HEALTH REFORM: OIG Issues Updated Guidelines for Evaluating State False Claims Acts: Is More State Litigation on the Horizon?

On March 15, 2013, the U.S. Department of Health and Human Services’ Office of Inspector General (“OIG”) released the Updated OIG Guidelines for Evaluating State False Claims Acts (“2013 Guidelines”), which replaces the...more

Worthless Services: Giving Nothing Can Cost You a Lot Under the False Claims Act

Numerous courts have recognized that knowingly billing the federal government for “worthless services” may be a violation of the False Claims Act (FCA). Recently, an Illinois nursing home learned how costly worthless services...more

Illinois Jury Found Nursing Home Liable For $28.1 Million In Whistleblower Case Alleging Substandard Care And Resident Abuse

An Illinois district court jury in United States v. Momence Meadows Nursing Center, Inc. recently issued a verdict on February 11, 2013 imposing $28.1 million in civil penalties on the operators of a nursing home. The nursing...more

DOJ Recovers Up To $48 Million in False Claim Act Case Resulting From Whistleblower Report

In yet another large recovery for the DOJ, on December 6, 2012, DFB Pharmaceuticals, and its subsidiary, Healthpoint Ltd., agreed as part of a settlement to pay up to $48 million to resolve allegations that Healthpoint caused...more

Ohio Hospital and Heart Center to Pay $4.4 Million to Resolve FCA Allegations

The U.S. Attorney’s Office for the Northern District of Ohio announced that EMH Regional Medical Center (EMH), a non-profit community hospital system located in Lorain County, Ohio, and North Ohio Heart Center, Inc. (NOHC),...more

Qui Tam Case Study: Dismissal Based On Whistleblower’s Lack Of Standing

Qui tam lawsuits — cases brought by private whistleblowers on behalf of the government — represent a growing risk for businesses that contract with the government or make claims as part of a government program, such as...more

2/3 Of DOJ’s Nearly $5 Billion Recovery Under False Claims Act Derived From Whistleblower Suits in 2012

On December 4, the Justice Department announced a record-breaking recovery of $4.9 billion in settlements and judgments in civil cases brought under the False Claims Act (FCA) for the fiscal year ending September 20, 2012....more

Hospitals Win a Case Challenging CMS Policy to Include Part C Days in the SSI Fraction in the Medicare DSH Formula

On November 15, 2012, the United States District Court for the District of Columbia released a 33-page opinion ruling in favor of a group of hospitals that had challenged CMS’s policy of including Medicare Part C patient days...more

Government Sanctioned for Destruction of Documents

U.S. district court decision may now allow defendants in False Claims Act cases to obtain sanctions where potentially relevant documents are lost or destroyed due to the government's failure to issue a timely litigation...more

Court Allows Challenge of RAC Recoupment Process

In a decision issued June 5, 2012, a federal district court allowed suit by a hospital challenging the validity of Medicare regulations providing that a contractor’s decision to reopen an initial determination is not...more

FCA Focus - March 2012

In This Issue: - EDITOR'S NOTE - RECENT DEVELOPMENTS • DOJ Civil Recoveries in FY2011 • Number of Qui Tam Actions Hits Record • Financial Fraud Cases Hitting Hard • Government Procurement -...more

New Jersey False Claims Act Is Not Retroactive

Qui tam claims by whistleblowers or relators are most commonly brought under the federal False Claims Act for 15-30% of whatever funds the Government recoups from Medicare fraud as an example. Yet, some states have legislated...more

Issue Brief: Individuals Excluded from Federal Health Care Programs or Federal Contracting: Protecting Your Organization

The enforcement of penalties for employing or contracting with individuals or businesses that are excluded from Federal Health Care Programs or Federal contracts seems to be on an upswing. While this is not a new issue,...more

U.S. ex rel. Stephen Paranich v. Sorngard, Irwin Leasing Corp

Physician as Whistleblower on Notice:Unnecessary Additional Information seen by Government as Self-Motivated Desire to be...

Physician as whistleblower or relator in a qui tam claim, pursuant to the False Claims Act, responded too vigorously to a limited Government subpoena by unnecessary and intensive internal investigations viewed by the...more