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The False Claims Act and the Health Care Industry: 2014 Year in Review

On Nov. 20, 2014, the U.S. Department of Justice (“DOJ”) announced settlements and judgments for False Claims Act (“FCA”) cases totaling $5.7 billion (compared to $3.8 billion in fiscal year 2013), $2.3 billion of which was...more

11th Circuit Brings Back Part of Whistleblower Suit

According to the ruling of the 11th U.S. Circuit Court of Appeals, a former health care executive that exposed a kickback and illegal referral scheme by his employer will be allowed to proceed with certain allegations listed...more

Administration Publishes Fall 2014 Unified Regulatory Agenda

We expect 2015 to be a very busy year for actions on new or proposed federal regulations in the absence of congressional legislation. That was confirmed on November 21, 2014, when the administration published its “Unified...more

Sixth Circuit Decision Confirms that Employers May Lawfully Choose Not to Hire a Job Applicant with a Prior History as a False...

Some employers in the health care and other industries who regularly deal with the federal government and are subject to the False Claims Act (“FCA”) have felt helpless in trying to weed out serial whistleblowers in the...more

Mintz Levin Health Care Qui Tam Update - Recent Developments & Unsealed Cases: November 2014

Trends & Analysis - In the period covered by this issue, we have identified 68 whistleblower cases related to health care that were unsealed. In this Qui Tam Update, we analyze the trends and take an in-depth look at...more

Blog: DOJ’s Record Year for FCA Recoveries Includes $2.3 Billion for Health Care Fraud

The Department of Justice (DOJ) announced this week that it recovered a record $5.69 billion in civil False Claims Act (FCA) settlements during fiscal year 2014. This recovery included $2.3 billion for FCA cases involving...more

Seventh Circuit Holds Pharmacy Billing Medicaid For Drug Prices Above Private Rates Is Not Fraudulent

On November 12, 2014, the Seventh Circuit upheld the dismissal of a False Claims Act action challenging a retail pharmacy chain’s practice of billing Medicaid for the price differential between the higher Medicaid-negotiated...more

Eleventh Circuit Limits Scope of FCA Whistleblower Suit

Late last month, a three-judge panel of the Eleventh Circuit Court of Appeals reinstated portions of a former executive’s False Claims Act (“FCA”) whistleblower action against Health Management Associates Inc. (“HMA”),...more

DC Circuit Dismisses Appeal By Three Hospitals Challenging Subcontractor Status

On November 14, 2014, the United States Court of Appeals for the District of Columbia dismissed as moot an appeal by three hospitals affiliated with the University of Pittsburgh Medical Center. The hospitals had challenged...more

Government turns up the heat with the False Claims Act – 5 action steps for healthcare providers

Forbes magazine has dubbed 2014 “The Year of the Whistleblower.” For healthcare providers, this designation has translated into millions of dollars in fines and penalties and the initiation of criminal investigations. ...more

DOJ Criminal Division Renews Efforts to Investigate Whistleblower Allegations

The Department of Justice (DOJ) has signaled a heightened effort to bring criminal prosecutors into the loop regarding False Claims Act referrals and other whistleblower complaints. In recent remarks at a conference comprised...more

The Seventh Circuit Rejects Medicaid False Claims Act Suit

The United States Court of Appeals for the Seventh Circuit affirmed the dismissal of a False Claims Act (“FCA”) case against Shopko Operating Stores, LLC, in which a former Shopko pharmacist asserted Medicaid billing...more

Seventh Circuit: No Fraud in Billing Medicaid More than Private Insurers for Drugs

Last Wednesday the Seventh Circuit affirmed the dismissal of a whistleblower suit brought by a pharmacist against his former employer, the Shopko pharmacy chain, for what he alleged was fraudulent billing of Medicaid by...more

Uncertain Privilege: Implied Waiver of the Attorney-Client Privilege in False Claims Act Litigation

In a pending False Claims Act (“FCA”) case stemming from alleged violations of the physician self-referral law (the “Stark Law”), 42 U.S.C. § 1395nn, and the federal Anti-Kickback Statute (“AKS”), 42 U.S.C. §1320a-7b, the...more

November Generality-in-Pleading Award

We’re only one-third of the way through the month of November, but we already have a winner of November’s Generality-in-Pleading Award. The hands-down winner is Dr. Warren Troxler, whose False Claims Act whistleblower suit...more

Whistleblowers Must Have Independent Knowledge to Actually Blow the Whistle

To bring a valid qui tam action and overcome the so-called “public disclosure bar” under the False Claims Act (“FCA”), a whistleblower must have direct knowledge of the alleged fraudulent activity, independent of already...more

Government demonstrates willingness to enforce Affordable Care Act provision that could cost providers millions of dollars

Under a little-known provision of the Patient Protection and Affordable Care Act (“ACA”), healthcare providers could face millions of dollars in liability for failing to reimburse the government for overpayments in a timely...more

Record-breaking Settlement for False Claims Act Cases

A company that operates 146 skilled nursing facilities agreed to pay $38 million to the United States and eight states to settle allegations brought under the False Claims Act (FCA). This settlement, brought about by the...more

California Legislation 2014

California Governor Jerry Brown has signed into law a number of bills that will impact the employer community. Healthy Workplaces, Healthy Families Act of 2014—Paid Sick Leave (AB 1522) - On September 10, 2014,...more

Third Circuit Tightens “Original Source” Requirement for Whistleblowers

Back in 2003 Karl Schumann filed a whistleblower suit alleging that as an executive with benefits company Medco, he learned that Bristol-Myers Squibb and AstraZeneca paid kickbacks to Medco to buy and recommend brand name...more

Mintz Levin Health Care Qui Tam Update - Recent Developments & Unsealed False Claims Act Cases: October 2014

Trends & Analysis - Between our last Qui Tam Update and the end of June, 65 health care–related qui tam cases were unsealed (28 in April, 18 in May, and 19 in June). Within those 65 cases...more

Employment Flash - September 2014

In This Issue: - SEC Pays First Whistleblower Award to Audit and Compliance Professional - Supreme Court Allows Affordable Care Act Contraceptives Religious Exemption - EEOC Adopts New Pregnancy...more

False Claims Act Update

New Criminal Division Review Process for Qui Tam Complaints Expands Main Justice Involvement and Threatens Greater Criminal Exposure in Whistleblower Investigations. The Assistant Attorney General for the Criminal...more

Eighth Circuit Clarifies False Claims Act Pleading Standards for Whistleblowers

The United States Court of Appeals for the Eighth Circuit recently held that whistleblowers may satisfy the False Claims Act’s (FCA) heightened pleading standards without providing representative examples of false claims,...more

Religious Exemptions for Employees

President Barack Obama recently signed an executive order that bans federal contractors from discriminating against the sexual orientation or gender identity of its employees. This order does not include a religious...more

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