News & Analysis as of

False Claims Act (FCA)

Client Alert: Feds Shine a Light on Medicare Advantage Plans and Physicians Related to Risk Adjustment Practices

Although the sufficiency of medical records documentation supporting beneficiary diagnoses for Medicare Advantage (MA) risk adjustment has been on the OIG’s work plan since 2013, the Department of Justice has upped the ante...more

Ninth Circuit Relies on Escobar to Revive False Claims Act Suit Against Pharmaceutical Manufacturer

On July 7, 2017, the U.S. Court of Appeals for the Ninth Circuit reversed a federal district court’s dismissal of a False Claims Act (FCA) whistleblower suit in United States ex rel. Campie v. Gilead Sciences, explaining that...more

Escobar case limits False Claims Act liability for providers

by Thompson Coburn LLP on

Health care providers, as government contractors, must make certain representations of fact when submitting claims for government program reimbursement, such as Medicare. Sometimes through no fault of the contractor, such...more

Ninth Circuit Relies on Escobar to Revive False Claims Act Suit Against Pharmaceutical Manufacturer

On July 7, 2017, the U.S. Court of Appeals for the Ninth Circuit reversed a federal district court’s dismissal of a False Claims Act (FCA) whistleblower suit in United States ex rel. Campie v. Gilead Sciences, explaining that...more

Deficient Administrative Record Leads Federal Court to Vacate 15-Year Debarment

by Blank Rome LLP on

A recent federal court decision vacating a staggering 15-year debarment based on shortcomings in the administrative record offers a glimmer of hope to contractors facing exclusion from federal programs, and reinforces the...more

Ninth Circuit Clarifies Tribal Arm Sovereign Immunity Factors

by Stinson Leonard Street on

The Ninth Circuit, in U.S. ex rel. Fawn Cain et al. v. Salish Kootenai College Inc. et al., recently reversed a lower court's dismissal of a False Claims Act lawsuit by former Salish Kootenai College employees. The False...more

Amounts Billed Do Not Indicate Fair Market Value In FCA Case

by Reed Smith on

Our day job has been keeping us busy, so busy with depositions, motions, delayed flights, and assorted drama that we have not posted in more than a month. After such a long layoff, we had hoped to return with a vengeance, a...more

The False Claims Act: Why It Is Relevant To All Manufacturers

The False Claims Act (FCA) is a major civil enforcement tool used by the federal government to redress fraud causing monetary loss to the government. In the 2016 fiscal year, the federal government recovered over $4.7...more

FCA Deeper Dive: Judicial Review of Settlements

by Bass, Berry & Sims PLC on

The FCA continues to be the federal government’s primary civil enforcement tool for investigating allegations that healthcare providers or government contractors defrauded the federal government. In the coming weeks, we...more

Evolutions in Whistleblowing: What Federal Contractors Need to Know

by PilieroMazza PLLC on

Last year produced major changes in the whistleblowing landscape: whistleblower protections for federal contractor employees who disclose waste, fraud, and abuse were made permanent under the National Defense Authorization...more

No Coverage for Multi-Million Dollar False Claims Act Settlement Due to Insured’s Failure to Provide Sufficient Details in Notice...

by Sedgwick LLP on

On June 23, 2017, Judge Lipman ruled in First Horizon National Corp., et al. v. Houston Casualty Co., United States District Court for the Western District of Tennessee Case No. 2:15-cv-2235 that First Tennessee Bank’s (Bank)...more

FCA Deeper Dive: Developments Regarding Penalties and Damages

by Bass, Berry & Sims PLC on

The FCA continues to be the federal government’s primary civil enforcement tool for investigating allegations that healthcare providers or government contractors defrauded the federal government. In the coming weeks, we...more

What Is Actual Knowledge? Third Circuit to Weigh in on Post-Escobar Materiality Question

by Pepper Hamilton LLP on

One year after the Supreme Court changed the False Claims Act landscape, FCA litigants continue to grapple with the “demanding” materiality standard set forth in Universal Health Services v. United States ex rel Escobar. Now...more

Mortgage Lender Pays $4.157 Million to Settle False Claims Act Allegations Concerning FHA Loans

by Goodwin on

On July 3, 2017, the United States Department of Housing and Urban Development (HUD), the HUD Office of Inspector General (HUD-OIG), the U.S. Attorney’s Office for the Northern District of Georgia, and the U.S. Attorney’s...more

Court Overreaches in Requiring Medical Necessity Determination by Labs

by Jones Day on

On June 9, 2017, the U.S. District Court for the District of Columbia denied a motion to dismiss brought by a laboratory in U.S. ex rel. Groat v. Boston Heart Diagnostics Corp., 2017 WL 2533341. Part of the grounds for...more

Third Circuit Recognizes Escobar “Heightened Materiality Standard” in Dismissal of False Claims Act Case Tied to Avastin

In May 2017, the U.S. Court of Appeals for the Third Circuit relied on the “heightened materiality standard” endorsed by the U.S. Supreme Court in its 2016 Escobar decision in dismissing a False Claims Act (FCA) whistleblower...more

FCA Deeper Dive: FCA’s First-to-File Bar

by Bass, Berry & Sims PLC on

The FCA continues to be the federal government’s primary civil enforcement tool for investigating allegations that healthcare providers or government contractors defrauded the federal government. In the coming weeks, we...more

Avoiding Risks with Referring Physician Compensation Arrangements

by Hinshaw & Culbertson LLP on

The settlement described below highlights the importance of carefully structuring compensation arrangements with referring physicians, and the risk involved in trying to work backwards to achieve a desired level of...more

Corporate Investigations and White Collar Defense - June 2017

U.K. Court Finds No Privilege Protection for Internal Investigation - Why it matters: On May 8, 2017, a London High Court made a landmark ruling in favor of the Serious Fraud Office—England’s equivalent of the Fraud...more

The Circuits are Split: The Ambiguity of a Regulation May Not ‘Foreclose a Finding of Scienter’ in False Claims Act Cases

by K&L Gates LLP on

A split now exists among the circuit courts as to whether a defendant’s assertion of a “reasonable interpretation defense” precludes a finding of a “knowing” mens rea under the False Claims Act (the “FCA”). On May 26, 2017,...more

Electronic Health Records Vendor Agrees to $155 Million Settlement to Resolve FCA Allegations, Required to Make Free Upgrades to...

by King & Spalding on

On May 31, 2017, the DOJ announced a $155 million settlement with eClinicalWorks (ECW), one of the nation’s largest electronic health records (EHR) vendors, to resolve a False Claims Act lawsuit brought by a whistleblower. ...more

Eleventh Circuit Affirms Two Grants of Summary Judgment in Favor of Diabetic Experts

by Bass, Berry & Sims PLC on

A unanimous panel of the U.S. Court of Appeals for the Eleventh Circuit (Eleventh Circuit) recently affirmed two grants of summary judgment in favor of defendant Lincare, Inc. d/b/a Diabetic Experts of America (collectively,...more

Limits On "Self-Help" Discovery In FCA Cases

As illustrated by a recent decision by a federal court in Massachusetts, it is not uncommon for an employee to take company documents that the employee believes will support a claim under the False Claims Act 31 U.S.C. 3729...more

After Escobar, Lower Courts Build On The “Materiality” Analysis for False Claims Act Lawsuits

by Saul Ewing LLP on

It’s been just over a year since the Supreme Court’s seminal False Claims Act (“FCA”) decision Universal Health Servs., Inc. v. United States ex rel. Escobar. In the wake of Escobar, the lower courts are confronted with...more

California Does Not Bar Defense Coverage For "Willful Acts"

"California prohibits insurers from indemnifying policyholders for their intentional misconduct, as a matter of public policy and as codified in California Insurance Code section 533. This bar on insurance coverage, however,...more

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