False Claims Act (FCA)

News & Analysis as of

Health Update - March 2017

The Future of Essential Health Benefits - Editor's Note: The Essential Health Benefits (EHB) rule may be among the many parts of the Affordable Care Act (ACA) that are on the chopping block as the Trump Administration and...more

The Latest On Statistical Sampling In FCA Cases

After waiting over a year to hear what the Fourth Circuit would say about statistical sampling in False Claims Act cases, the court of appeals recently chose to keep us in suspense. Despite initially granting the relators’...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

"Key Takeaways: Lessons Learned From Tax-Related Whistleblower Litigation and Shareholder Actions"

On March 8, 2017, Skadden hosted a webinar titled “Lessons Learned From Tax-Related Whistleblower Litigation and Shareholder Actions.” The Skadden panelists were tax partners Nathaniel Carden and Armando Gomez, and litigation...more

Federal district court interprets Stark Laws writing requirement

On March 15, 2017, the US District Court for the Western District of Pennsylvania, ruling on cross motions for summary judgment in U.S. ex rel. Tullio Emanuele v. Medicor Associates Inc. et al., provided the first...more

Government Wants to Settle, Whistleblowers Don’t

What happens when the government wants to settle a False Claims Act case, but the whistleblowers who filed the case don’t? That was the question before the U.S. District Court for the District of Colorado. Airport...more

Agape Take Two - 4th Circuit Court of Appeals Rules on FCA Statistical Sampling Case

Last May, we reported on a False Claims Act (FCA) case pending in the 4th Circuit Court of Appeals regarding a claim brought in the U.S. District Court in South Carolina against a network of 24 nursing home providers...more

The Siege Continues: The Justice Department Is Investigating Four Additional Medicare Advantage Plans On Risk Adjustment Issues

WHO IS AT RISK - The federal government has indicated that it is still investigating, and could ultimately join a false claims whistleblower qui tam action against Aetna, Inc., Humana, Inc., Cigna, Inc. (through its Bravo...more

Fifth Circuit Dismisses False Claims Act Suit Alleging Violation Of Offshore Regulations

In Abbott v. BP, the plaintiffs alleged that BP had falsely certified to compliance with regulatory requirements pertaining to the engineering of the Atlantis Platform, a semi-submersible floating production facility capable...more

Mintz Levin Health Care Qui Tam Update - Recently Unsealed Whistleblower Cases: March 2017

Trends & Analysis - ..This issue looks at 18 health care–related qui tam cases that were unsealed in whole or in part in late October through November 2016. ..The cases identified were filed in federal district courts...more

DC Federal Court Grants Summary Judgment to Halliburton in Important FCA Case

On March 14, U.S. Federal Judge Royce Lamberth granted Halliburton’s motion for summary judgment and dismissed Mr. Barko’s claims against Halliburton, filed under the False Claims Act (FCA), which, along the way, resulted in...more

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

Featured Unsealed Cases United States ex rel. Thomas v. Best Choice Home Health Care Agency, Inc., No. 2:13-cv-02209 (D. Kan.) - Complaint Filed: May 6, 2013 - Complaint Unsealed: October 24, 2016...more

Key Takeaways From FHA’s Health Law Summit

Foley recently co-hosted the Florida Hospital Association’s (FHA) 2017 Health Law Summit, which brought together more than 40 in-house attorneys and compliance officers from FHA member hospitals to discuss the current state...more

Pharmaceutical Manufacturers and Healthcare Leaders cite Fraud and Abuse Laws as Obstacle to Value-Based Arrangements

As the healthcare industry moves towards value-based purchasing, pay-for-performance, and other payment reform models, industry leaders have identified federal fraud and abuse laws as a barrier to full implementation of such...more

False Claims Act Dangers on Display in Ruckh

A recent jury verdict in an FCA lawsuit pending in the United States District Court for the Middle District of Florida resulted in a not-so-subtle reminder of just how high the stakes can be in such litigation....more

Health Care FCA Decisions Applied to Criminal Case

False Claims Act (“FCA”) cases involving medical necessity continue to receive great attention. A March 7, 2017 opinion that overruled a jury’s criminal fraud conviction of a cardiologist demonstrates the broader implications...more

Court Examines Standard for Approval of Settlement of Qui Tam Over a Relator’s Objection

The False Claims Act (FCA) allows plaintiffs/relators to bring qui tam actions, in which the government may then elect to intervene. The FCA also provides that “[t]he Government may settle a [qui tam] action with the...more

Tax Highlights of Proposed Illinois “Grand Bargain”

In an effort to resolve Illinois’ 20-month budget impasse, the Illinois Senate leadership (Senate Majority Leader John Cullerton and Senate Minority Leader Christine Rodogno) have jointly proposed a series of bills to...more

Direct Primary Care: Getting Calls from Patients While Avoiding Calls from Law Enforcement

For providers interested in simplifying the provider-patient relationship, one option is direct primary care. Ironically, though, simplification can be complicated, particularly when the government is involved. One of the...more

OIG Releases FY 2016 Statistical Data About Medicaid Fraud Control Units

Earlier this week, the Office of Inspector General for the Department of Health and Human Services (“OIG”) posted its fiscal year (“FY”) 2016 data about Medicaid Fraud Control Units (“MFCUs”) across the country....more

SCOTUS Ruling Revives FCA Claim Against Wells Fargo

On February 21, 2017, the U.S. Supreme Court issued an order remanding a False Claims Act (FCA) case, Bishop v. Wells Fargo & Co., No. 15-2449 (2d Cir. 2016), to the Second Circuit for further consideration of the...more

Taking Shape: Influential D.C. Circuit Court Continues the Expansion of Escobar’s “Materiality” Standard

In June 2016, the Supreme Court’s decision in Universal Health Services, Inc. v. United States ex rel. Escobar confirmed the viability of the “implied false certification” theory of liability under the False Claims Act (FCA)....more

New OIG Exclusion Authority Rule Set To Go Into Effect on March 21, 2017

On January 12, 2017, just a week prior to President Trump’s Inauguration, the Department of Health and Human Service (HHS) Office of Inspector General (OIG) published a final Rule (Rule) regarding one of its most important...more

A Parallel Universe: Navigating Discovery in Concurrent Civil and Criminal Proceedings

As criminal law has expanded into almost every sector of the American economy, one byproduct is the rise of "parallel proceedings"—lawsuits that proceed concurrently in criminal and civil court based on largely the same...more

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