False Claims Act (FCA)

News & Analysis as of

AGG Litigation Insights Newsletter - Summer 2016

Even for companies accustomed to civil lawsuits, when the government is on the other side of the “v,” the prospect of litigation can be intimidating and unfamiliar. In this issue of the Litigation Newsletter, we explore how...more

The Law Doesn’t Forbid Submitting False Claims

An Eighth Circuit decision provides a reminder that the False Claims Act doesn’t forbid submitting false claims: it forbids knowingly submitting false claims. That made all the difference in an appeal of summary judgment in...more

4 Steps For Avoiding FCA Traps For SBA Lenders

Recent U.S. Department of Justice enforcement and qui tam suits demonstrate that Small Business Administration lenders face increasing risk of liability under the False Claims Act. This article provides an overview of SBA...more

False Claims Act Cases: With No End In Sight, Why You Should Consider Litigating And How To Maximize Your Litigation Advantages

Over the past few years, the government’s emphasis on conducting fraud and abuse investigations – especially in the healthcare industry – has resulted in scores of settlements and billions of dollars paid to the government...more

Don’t Discount the Government’s Recent Statement of Interest in False Claims Act Case

On August 8, 2016, the U.S. government filed a Statement of Interest in an ongoing False Claims Act (FCA)/Anti-Kickback Statute (AKS) case, U.S. ex rel. Herman v. Coloplast Corp., No. 1:11-cv-12131 (D....more

The Changing Landscape of FCA Litigation for Healthcare Providers Due to Increased Civil Penalty Amounts

Since the late 1990s, the False Claims Act (“FCA”) has heavily affected the healthcare industry. In 2015, two-thirds of FCA lawsuits targeted healthcare entities, which paid out $1.9 billion. However, it is likely that this...more

DOJ Doubles Penalties for Violation of the False Claims Act

The Department of Justice (“DOJ”) has issued an interim final rule that dramatically increases the dollar amount for civil penalties that can be assessed against an entity or individual who violates the False Claims Act...more

Texas Diagnostic Imaging Service Settles FCA Allegations for $3.5 Million; Whistle-Blower to Receive $596,700

A recent settlement illustrates the substantial recovery available to whistle-blowers under the FCA’s qui tam provisions. Those provisions allow a qui tam plaintiff to receive typically between 15 percent and 25 percent of...more

The Department of Justice Ups the Ante: Per Claim Penalties for False Claims Act and Anti-Kickback Statute Violations Nearly...

On June 30, 2016, the Department of Justice (“DOJ”) published an interim file rule that dramatically increases the per claim penalties for violations of the False Claims Act (“FCA”) and the Anti-Kickback Statute (“AKS”) among...more

Ninth Circuit: Manipulation of Risk Adjustment Data Subjects Insurers to False Claims Act Liability

The U.S. Court of Appeals for the Ninth Circuit has revived a whistleblower suit against Aetna, UnitedHealthcare and WellPoint for allegedly submitting false data for Medicare Advantage payments. Some of the nation’s largest...more

DOJ Files FCA Complaint Against Recipient of Grant Funding

The FCA began as a response to procurement fraud by military contractors during the Civil War. In the intervening years, its reach has extended and increasingly the government is using the FCA as a tool in the context of...more

CMS Audit Practices: How false can you get?

Caring Hearts Personal Home Care Services provided physical therapy and skilled nursing services to homebound Medicare patients. During an audit, CMS determined that Caring Hearts provided services to patients who didn’t...more

Tenth Circuit Holds that the False Claims Act’s Materiality Requirement Has Teeth in Granting Summary Judgment to Government...

On April 22, 2016, in a decision issued before the Supreme Court’s Escobar opinion, the Tenth Circuit addressed the question of what a relator must show to meet the materiality requirement in an implied false...more

Pratt's Government Contracting Law Report

In a unanimous decision, the U.S. Supreme Court recently upheld the “implied certification” theory of liability under the False Claims Act, while emphasizing that only material misrepresentations are actionable. In this...more

Provider-Based Rule and Stark—Is Joint Compliance Impossible in 2017?

The Centers for Medicare & Medicaid Services (CMS) will be putting hospitals in an untenable position if recent proposed rulemaking is implemented as is. In its proposal for acting on legislation reducing payments to new,...more

Trade & Manufacturing - News of Note - August 2016

ITC Votes to Extend Antidumping Duties on Imports of Porcelain-on-Steel Cooking Ware from China for Five More Years - On July 12, the International Trade Commission (ITC) voted 5-0 to extend the U.S. antidumping duty...more

Pharmaceutical Manufacturer’s Possible Settlement Shows Long-Arm of FCA

On Tuesday, August 2, 2016, pharmaceutical and biotech company Shire PLC filed a Form 8-K announcing a possible resolution to an ongoing FCA investigation into the sales and marketing tactics of Shire’s “Dermagraft” skin...more

Mintz Levin Health Care Qui Tam Update - Recently Unsealed Whistleblower Cases: August 2016

Since our last issue, we have identified 31 recently unsealed health care-related whistleblower cases. In this Qui Tam Update, we analyze the trends and take an in-depth look at a few noteworthy cases....more

Doctor Gets $4.6M for Blowing Whistle on Over-Compensated Doctors

Neurologist Dr. David Hammett will receive $4,590,000 as part of a settlement entered into by Lexington Medical Center (LMC) of West Columbia, S.C., and the federal government. Ironically, the hefty compensation comes as a...more

Business Litigation Report - July 2016

Article: Increase in Vertical Price Restraint Enforcement in China - In recent months, Chinese anti-monopoly enforcement actions scrutinizing and penalizing pricing-related issues have noticeably increased. A growing...more

Health Care Market Intelligence: Post-Acute Care Summary Report - Q2 2016

Key Findings - - CMS proposed an $800-million Medicare payment increase for SNFs in FY 2017, a 2.1% increase from this year, while hospice payments would rise by $330 million, or 2%. Home healthcare agencies may see a...more

July 2016: Product Liability Update

Curbing False Claims Act Liability for Off-Label Promotion. As class actions have become harder to certify following Wal-Mart v. Dukes and Comcast v. Behrend, the plaintiffs’ bar has increasingly turned to qui tam litigation...more

Increased False Claims Act Penalties Carry Hidden Risks

On June 30, 2016, the Department of Justice published an Interim Final Rule adjusting for inflation the civil monetary penalties arising from violations of the False Claims Act (FCA). Currently, civil monetary penalties range...more

First Circuit Limits Inference of Pretext for FCA Retaliation Claims

On February 22, 2016, the First Circuit affirmed a grant of summary judgment for pharmaceutical maker GlaxoSmithKline (“GSK”) on a False Claims Act retaliation claim by a former employee. In United States ex rel. Hamrick v....more

Health Update - July 2016

The Vulnerability of Healthcare Information - According to a report the Brookings Institute issued in May 2016, 23% of all data breaches occur in the healthcare industry. Nearly 90% of healthcare organizations had some...more

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