False Billing

News & Analysis as of

Mintz Levin Health Care Qui Tam Update: Recent Developments & Unsealed Cases - September 2015

Trends & Analysis - Since our last Qui Tam Update, we have identified 39 health-related False Claims Act (“FCA”) qui tam cases that have been unsealed. Of those cases...more

Prosecuting Doctors for Medicare Fraud

Federal prosecutors have turned their attention to physicians for Medicare fraud prosecution. Physicians who participate in the Medicare program have to be aware of the significant risks of Medicare fraud....more

What were they thinking?

I can’t even make stuff like this up. Lawyers and invoices are a toxic combination, but the AmLaw 200 firms that are responsible for these examples have people who are supposed to prevent the lawyers from revealing their...more

Whistleblower's Criminal Conduct Prevents FCA Payout

The United States Court of Appeals for the Ninth Circuit prevented a False Claims Act (“FCA”) relator from receiving a share of a $19 million settlement stemming from the defendant’s alleged false billing on a nuclear cleanup...more

Tuomey Judgment Upheld in Novel Stark Law and False Claims Act Case

The U.S. Court of Appeals for the Fourth Circuit recently upheld the judgment against Tuomey Healthcare System, Inc. (Tuomey), in a qui tam False Claims Act case predicated on Stark Law violations. The district court in the...more

Trinity Homecare Settlement: Five False Claims Trends

New York State Attorney General Eric Schneiderman recently announced that his office had reached a $2.5 million settlement in a federal False Claims Act (FCA) case with Trinity HomeCare and its related entities. The case,...more

Obama Administration Announces Record Medicare Strike Force "Takedown"

On June 18, 2015, HHS Secretary Sylvia M. Burwell and Attorney General Loretta E. Lynch announced that a nationwide Medicare Fraud Strike Force sweep resulted in health fraud charges against 243 individuals involving...more

Latest Medicare Fraud Strike Force Takedown Is The Most Significant To Date

As we discussed yesterday, the Medicare Fraud Strike Force’s eighth annual nationwide takedown resulted in charges in 17 districts against 243 individuals for approximately $712 in false billings. It is the most...more

Largest Criminal Health Care Fraud Takedown – 243 Charged and $712 Million in False Billings

On June 18, 2015, HHS Secretary Sylvia M. Burwell and DOJ Attorney General Loretta E. Lynch announced nationwide arrests in Medicare fraud schemes amounting to approximately $712 million in false billings. Attorney General...more

Growing Use of Sampling in FCA Cases

In prior years, sampling has been at issue in FCA cases largely in the context of damages. Specifically, where there were allegations of a specific course of wrongful conduct that allegedly impacted large volumes of claims,...more

The Federal False Claims Act - Violations of Conditions of Payment or Conditions of Participation?

With the increase of Qui Tam lawsuits alleging violations of the federal False Claims Act ("FCA"), it is important to understand that FCA liability maybe predicated on whether the alleged wrongful act violated a condition of...more

Hospice Provider Pays $4 Million to Settle Allegations of Fraudulent Billing

Good Shepherd Hospice, Inc., a for-profit hospice providing services in Oklahoma, Missouri, Kansas, and Texas (“Good Shepherd”), has agreed to pay $4 million to the U.S. government to settle allegations that it submitted...more

Supreme Court Rejects Whistleblower’s Double-Dip Attempt

On Monday the United States Supreme Court declined to hear Danny Smart’s appeal of the Fifth Circuit’s rejection of his attempt to share in the proceeds of a $5 million settlement of a False Claims Act suit brought by another...more

Hospital Settles Provider-Based Compliance Investigation for $3.3 Million

A New York State hospital has agreed to pay the U.S. Department of Justice more than $3.3 million to resolve an investigation conducted by the HHS-OIG and U.S. Attorney’s Office for the Northern District of New York into...more

Provider of Physical, Speech, and Occupational Therapy Services Agrees to $38,000,000 False Claims Act Settlement

As announced in an recent press release, Extended Care Health Services, Inc. (“Extendicare”), an operator of skilled nursing facilities, and its subsidiary Progressive Step Corporation (“Pro Step”), a provider of physical,...more

Fifth Circuit Holds Multiple Disclosures Establish Loss Causation in Securities Action

The US Court of Appeals for the Fifth Circuit recently held that multiple partial “corrective” disclosures collectively may satisfy the requirements of pleading loss causation in a securities fraud class action, even if no...more

Brace Yourself: The RACs Are Back

Under the controversial program private contractors audit hospitals and other Medicare providers for fraudulent and erroneous Medicare billing. Why is it controversial? Because the auditors are paid a percentage of...more

The Halifax $85 Million Lesson: Compensation Arrangements Between Hospitals and Physicians Must Be Reviewed

The Department of Justice (“DOJ”) announced another multi-million dollar settlement of alleged False Claims Act violations on March 11, 2014. Specifically, Halifax Hospital Medical Center and Halifax Staffing, Inc. agreed to...more

Whistleblower’s one-two punch: Confidential informant/employee spurs criminal investigation, then successfully sues individual...

Schuylkill Products case highlights how a whistleblower can put an employer on track to face both criminal and civil proceedings under the False Claims Act....more

Second Circuit Dismisses $50 Million FCA Suit

Last week, the United States Court of Appeals for the Second Circuit affirmed the dismissal of a False Claims Act (“FCA”) whistleblower suit seeking $50 million in damages from Huron Consulting Group Inc. (“Huron”) for...more

Recent FCA Decision Has Important Implications for Contractor Disclosures to the Government

A recent decision from the U.S. District Court for the Eastern District of Virginia has important implications for government contractors that make mandatory disclosures of improper conduct to the U.S. Government. In U.S. ex...more

Eastern District of Virginia Finds False Claim Allegations Too Speculative

A Virginia federal judge recently dismissed a retaliation complaint under the False Claims Act because the plaintiff’s allegations of a false claim against the government were too speculative. In Carlson v. DynCorp...more

Long Island Radiology Group Settles FCA Allegations That It Billed Medicaid And Medicare For Unnecessary Tests For $15.5M

A company operating diagnostic testing facilities in New York has agreed to pay $13.65 million to the federal government and $1.85 million to New York and New Jersey for a total of $15.5 million in penalties to settle claims...more

Medical Device Manufacturer Settles False Billing Allegations for up to $5.25 Million

On February 19, 2014, the DOJ announced it reached a settlement with EndoGastric Solutions, Inc. (EndoGastric) to resolve a pending False Claims Act (FCA) suit. EndoGastric manufactures and sells a medical device called...more

Everyone Gets To See The Evidence: The California Court Of Appeal Rejects an Attorneys’ Fee Award Based On The Trial Court’s In...

In Concepcion v. Amscan Holdings, Inc. et al., — Cal.Rptr.3d —-, 2014 WL 595822 (Cal.App. 2 Dist. Feb. 18, 2014) the California Court of Appeal rejected class counsel’s fee award where class counsel’s billing records were...more

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