News & Analysis as of

Dept. of Justice False Claims Act (FCA)

The United States Department of Justice is a federal executive department established in 1870 by federal statute. The Department is headed by the Attorney General and is responsible for administering and... more +
The United States Department of Justice is a federal executive department established in 1870 by federal statute. The Department is headed by the Attorney General and is responsible for administering and enforcing federal law. The Department is compromised of many different divisions which handle a wide variety of civil and criminal issues.    less -

Medicare Advantage Plans Under Fire: The Department of Justice Files Complaints-in-Intervention

As reported in earlier blogs, the federal Department of Justice (DOJ) has been actively looking into potential abuses by Medicare Advantage (MA) Organizations as to allegedly improper risk adjustment claims submissions and...more

Hospital and its Clinic Agree to $34 Million Settlement to False Claims Act Allegation that Compensation to Oncologists Violated...

Last week, the Department of Justice (DOJ) entered into a $34 million settlement with Mercy Hospital Springfield (“Hospital”) of Springfield, Missouri, and its affiliate Mercy Clinic (“Clinic”). The settlement resolves an...more

Reverse Mortgage Servicer to Pay $89 Million to Resolve False Claims Act and FIRREA Claims

by Goodwin on

On May 16, 2017, the U.S. Department of Justice (“DOJ”) announced that it had reached a settlement with a company engaged in reverse mortgage servicing, in connection with the company’s participation in the Department of...more

False Claims Act Litigation and Implications for D&O and Professional Liability Insurers

by Sedgwick LLP on

The Federal False Claims Act - 31 U.S.C. §§ 3729-3733 (the ‘‘FCA’’) permits private plaintiffs to pursue claims on behalf of, and sometimes with the intervention of, the U.S. Department of Justice (‘‘DOJ’’), against those...more

Why Healthcare and Life Sciences Companies Need to Step Up Their Compliance Efforts in Advance of a U.S. Government Investigation

by Hogan Lovells on

In this hoganlovells.com interview, Hogan Lovells partner Gejaa Gobena discusses how the perception of compliance, remediation, and self-disclosure has evolved in the eyes of government prosecutors from how they factor at...more

Judge Has No Interest in DOJ’s Statement of Interest

by Faegre Baker Daniels on

In yet another demonstration of the benefits of lifetime tenure, a federal judge in Florida has told the Department of Justice to take a hike. It happened when the DOJ asked for permission to submit a “statement of interest”...more

Energy & Process Corp. Settles Whistleblower Action Related to Construction of Nuclear Waste Treatment Facility

by Dorsey & Whitney LLP on

On Monday, April 24, the U.S. Department of Justice announced that Energy & Process Corp. agreed to pay $4.6 million to settle False Claims Act allegations concerning the construction of a large nuclear waste treatment...more

Top False Claims Act developments In 2017 for ADG companies

by Hogan Lovells on

The False Claims Act, 31 U.S.C. §§ 3729-3733, continues to pose unique liability risk for aerospace, defense, and government services (ADG) companies that directly or indirectly conduct business with the U.S. Government. In...more

A “Change of Heart” in a Health Care Fraud Prosecution - Inconsistent angiogram interpretations establish reasonable doubt in...

On March 7, 2017, the U.S. District Court for the Eastern District of Kentucky reversed the October 27, 2016 criminal jury verdict against Kentucky cardiologist Dr. Richard E. Paulus, and acquitted him on all counts of health...more

Corporate Investigations and White Collar Defense - March 2017

DOJ's New Guidance for Evaluating Corporate Compliance Programs - Why it matters: On February 8, 2017, the DOJ released, to little fanfare, a new guidance document entitled "Evaluation of Corporate Compliance Programs."...more

MWI Case Shows The False Claims Act Needs A Change

Imagine your company becomes the subject of a U.S. Department of Justice investigation, which goes on for 30 months and ends with no grand jury indictment or criminal prosecution. Then, in a recalcitrant pivot, the DOJ...more

The Siege Continues: The Justice Department is Investigating Four Additional Medicare Advantage Plans

In our prior blog post, we reported that, at the request of the federal Department of Justice, the FCA qui tam whistleblower lawsuit in the case of United States ex rel Benjamin Poehling v. United HealthGroup, Inc., et. al....more

DOJ Issues New Guidance on the Evaluation of Corporate Compliance Programs in Federal Fraud Investigations

On February 8th, the U.S. Department of Justice (DOJ) quietly issued new guidance on how the agency evaluates corporate compliance programs during fraud investigations. The guidance, published on the agency’s website as the...more

DOJ Intervenes in Risk Adjustment FCA Case

by Bass, Berry & Sims PLC on

Recently, the DOJ intervened in one of several currently pending qui tam cases involving Medicare Advantage (MA) and the Risk Adjustment process used to determine the amount of payments to Medicare Advantage Organizations...more

Medicare Advantage Plans Under Siege: Another Whistleblower Lawsuit

In a court decision last year in Swoben v. United Healthcare, the United States Court of Appeals for the Ninth Circuit held that an allegation – that a Medicare Advantage Plan performed a “biased” HCC-RAF retrospective...more

Proof by Proxy in FCA Suits? District Court Says It Depends

by Morgan Lewis on

Admissibility of statistical sampling to prove liability in FCA suit is fact dependent. In a February 14, 2017 decision, the Fourth Circuit declined to rule on the question of whether statistical sampling can be used to...more

Fourth Circuit Takes a Pass on Statistical Sampling, Finds DOJ's Settlement Veto Authority Unreviewable

by Bass, Berry & Sims PLC on

After granting the relators’ petition for an interlocutory review of the district court’s rejection of the use of statistical sampling to establish FCA liability, the Fourth Circuit ultimately declined to reach that issue in...more

Health Care Fraud and Abuse in the Middle District of Florida in 2016 - a Year in Review

by Carlton Fields on

The United States Attorney’s Office (USAO) for the Middle District of Florida (USAO-MDFL) prosecuted several civil health care fraud matters in 2016 and issued related press releases. A review of the USAO-MDFL’s criminal and...more

Fourth Circuit Permits DOJ to Reject an FCA Settlement, But Punts Decision on Statistical Sampling

In a closely watched False Claims Act (“FCA”) case, the Fourth Circuit Court of Appeals decided that the Department of Justice (“DOJ”) has an unreviewable right to object to a proposed settlement agreement between a relator...more

DOJ Settles with Nursing Home for Allegations of Worthless Services

by King & Spalding on

On February 1, 2017, an Iowa nursing facility and residential care facility operator entered into a settlement agreement (the Agreement) with DOJ and the State of Iowa for alleged violations of the False Claims Act for the...more

Fraud and Abuse Investigations Should be Taken Very Seriously

by Burr & Forman on

According to the United States Government, fraud and abuse recovery has an excellent return for each investment dollar spent. According to the Health Care Fraud and Abuse Control (HCFAC) Program Report,released by the...more

Corporate Investigations and White Collar Defense - February 2017

When Regulatory Failings Turn Criminal: Car Edition Redux - Why it matters: To paraphrase the famous quote from the film “All About Eve”: Fasten your seatbelts, it’s going to be a bumpy car ride. In the first part of...more

2016 Saw Rise in False Claims Act Actions and Recoveries

by PilieroMazza PLLC on

The U.S. government and whistleblowers brought an increased number of False Claims Act (“FCA”) cases – as well recovered a larger amount in settlements and judgements – in the fiscal year 2016, as compared to 2015. In 2016,...more

White Collar Enforcement and the New Trump Administration: Your Top Ten Questions Answered

by Foley & Lardner LLP on

Enforcement activity under the Obama administration often made headlines for the eye-popping level of fines, with the Foreign Corrupt Practices Act (FCPA), Anti-Money Laundering (AML) regulations, and economic sanctions...more

Attorney General Sessions' Focus on Fraud Enforcement to Have Immediate Impact on Federal Government Contractors

by BakerHostetler on

Today, Feb. 9, former U.S. Senator Jeff Sessions was sworn in as the 84th Attorney General of the United States. While today marked only the beginning of his term, Attorney General Sessions’ record as a former federal...more

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