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The Pitfalls of Settling Qui Tam Lawsuits

In a recent federal court case, the federal government and the State of California successfully enforced an oral settlement agreement of a qui tam lawsuit against a health care provider. United States v. North East Medical...more

Maine to Pay Out $142,500 to Settle Whistleblower Suit

The state Department of Health and Human Services in Maine will pay $142,500 to a former employee as a part of a settlement for a federal whistleblower suit. That employee is Sharon Leahy-Lind, who was at one time a...more

NJ Appeals Court Upends Nursing Home Negligence Suit

In a decision with far-reaching ramifications for long-term care litigation, the Superior Court of New Jersey, Appellate Division held that § 30:13-4.2 of the Nursing Home Responsibilities and Residents’ Rights Act (NHA) does...more

Dignity Health Pays $37 Million After Claims of Overbilling

Major whistleblower claims have been occurring in a wide variety of industries lately. One of the industries in which fraud is most prevalent is the health care industry, and this past fall an instance of fraud cost a...more

Judge Orders State’s Termination of Provider’s Medicaid Contract To Be REVERSED, Despite the Unilateral Termination!!

Imagine that the State of North Carolina knocks on your office door and informs you that you are no longer allowed to accept Medicaid and/or Medicare reimbursement rates. That for whatever reason, you are no longer allowed to...more

FDA Approves First US Biosimilar but Court Action Could Delay Market Entry

On March 6, 2015, the U.S. FDA announced that it had approved Zarxio, making Sandoz the first company ever to obtain approval of a biosimilar product in the U.S. The FDA deemed Zarxio to be biosimilar to Amgen’s Neupogen...more

Anatomy of a Provider-Merger Antitrust Challenge (Part 3)

This is the third in a six-part series discussing the Federal Trade Commission's challenges to provider mergers. Following the initial Introduction and Background (Part 1), the series discusses The Need for Early Legal Advice...more

Appellate Court Notes

SC18928 - Rathbun v. Health Net of the Northeast, Inc. - In Connecticut, the Department of Social Services manages the federal Medicaid act and awards contracts to Medicaid managed health care providers. The defendant...more

The FCA and the Ever-Narrowing Public Disclosure Bar

On February 25, 2015, the Sixth Circuit became the latest federal court of appeals to weigh in on the scope of the False Claims Act’s (FCA) public disclosure bar in its decision in United States ex rel. Whipple v....more

Ninth Circuit Affirms Divestiture of Consummated Physician Practice Acquisition

The U.S. Court of Appeals for the Ninth Circuit affirmed an Idaho federal district court’s decision ordering the divestiture of a physician practice group that had been acquired by a competing health system. The case, which...more

California's Patients' Rights Statute Limits Statutory Damages to a Maximum of $500, Not $500 Per Violation

In Lemaire v. Covenant Care California, LLC, 2015 WL 340677, the Second District Court of Appeal held that while patients may sue nursing facilities under California Health & Safety Code §1430(b) for violation of federal and...more

Supreme Court Rules NC Dentist Board Not Immune From Antitrust Scrutiny

In a 6-3 decision, the Supreme Court ruled that state professional boards comprised of active market participants are not immune from antitrust laws even though the boards are formally designated as a state agency, unless the...more

CMS Delays 60-Day Rule, But Overpayment Case Law Emerging

The Centers for Medicare & Medicaid Services (CMS) recently announced a one-year delay in finalizing the long-awaited and closely watched rule addressing the 60-day deadline to return Medicare and Medicaid overpayments (the...more

Court Dismisses Data Breach Class Complaint For Lack Of Standing

On February 11, 2015, the U.S. District Court for the Southern District of Texas held that a plaintiff lacked standing to pursue claims for alleged violations of the Fair Credit Reporting Act, 15 U.S.C. § 1681 et seq....more

Classic Antitrust Principles Apply to Health Care Mergers Even Post-ACA

The Ninth Circuit last week held that St. Luke’s Health System’s purchase of a physician practice group violated federal antitrust laws. In doing so, it upheld a district court’s order that the merger be dissolved. ...more

Standard Of Reasonableness In Contract With Public Body: Wednesbury Not Applied

In David Krebs v NHS Commissioning Board (As successor body to Salford Primary Care Trust) [2014] EWCA Civ 1540 The Court of Appeal ruled that the NHS Commissioning Board (NHSCB) had not acted unreasonably in terminating a...more

The Surprise Cost of Whistleblowing

On February 3, 2015, in United States v. Huron Consulting Group, Inc., U.S. District Judge Jed S. Rakoff, took the unusual – but not unprecedented – step of ordering a False Claims Act (“FCA”) relator to pay thousands of...more

St. Alexius Medical Center of Hoffman Estates To Pay $125,000 to Resolve EEOC Disability Suit

Hospital Fired Employee With Cognitive Disabilities Rather Than Reasonably Accommodate Her, Federal Agency Charged - CHICAGO - St. Alexius Medical Center of Hoffman Estates will pay $125,000 to a former employee as...more

Tennessee Home Health Care Agency to Pay $25 Million in Whistleblower Settlement

CareAll Management LLC, a Tennessee-based agency that provides in-home health care services, must pay $25 million to settle a whistleblower suit. The agency came to an agreement with the United States Department of Justice...more

California Physician Pleads Guilty to Failing to File FBAR for Bank Leumi Account

On February 2, 2015, Baruch Fogel, a California doctor, pleaded guilty in the U.S. District Court for the Central District of California to one count of willful failure to report the existence of a foreign bank account on a...more

Does Med Mal Statute of Limitations Apply to Indemnification Claims?

Last week the South Carolina Supreme Court issued an opinion addressing the issue whether an indemnification claim is subject to that state’s medical malpractice statute of limitations, when the claim is for recovery of a...more

False Claims Act – 2014 Year in Review

The False Claims Act (FCA) imposes liability on individuals and companies who defraud or submit false claims to the federal government. The FCA allows the federal government to seek treble damages, civil penalties and...more

HIPAA Violation — Pharmacy Held Liable for Employee’s Misdeeds

Recently, the Indiana Court of Appeals let stand a $1.4 million jury verdict against a national pharmacy chain for its employee pharmacist’s unauthorized disclosure of a customer’s confidential medical records.  Given the...more

2014 Review: The New York False Claims Act

There was significant activity in 2014 in matters involving the New York False Claims Act (NY FCA). This review summarizes the legislative activity, case law developments and noteworthy settlements in 2014....more

Health Care Enforcement in 2015: A Look Back on 2014 and Forecasting the Year Ahead

In testimony before the House Oversight and Government Reform Subcommittee on Health Care in April 2011, the now-pending nominee for U.S. Attorney General, Loretta E. Lynch, stated in no uncertain terms that “fighting health...more

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