News & Analysis as of

False Claims Act (FCA) Vacated

Holland & Knight LLP

Federal Judge Cites Ambiguous Coding Guidance, Vacates Doctor's Healthcare Fraud Conviction

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A federal judge recently exposed weaknesses in the U.S. Department of Justice's (DOJ) criminal healthcare fraud enforcement efforts by vacating a jury's conviction of a prominent Maryland doctor. On Aug. 4, 2023, a federal...more

Proskauer - Health Care Law Brief

The Supreme Court’s Ruling Narrows Available FCA Scienter Defenses

In a unanimous opinion, the United States Supreme Court (“Court”) recently held that the False Claims Act’s (“FCA”) scienter requirement refers to a defendant’s knowledge and subjective beliefs, rather than what a...more

Health Care Compliance Association (HCCA)

Hooper, Kearney and Macklin on Cutting Edge Topics in the False Claims Act

While the pandemic put many things on hold, it did not do the same for the False Claims Act (FCA). To find out what is happening in FCA activity we spoke with Patrick Hooper, Jordan Kearney and Alicia Macklin, partners at the...more

K&L Gates LLP

HHS OGC Weighs in on Sub-Regulatory Guidance in Advisory Opinion: What It Might Mean for False Claims Act Cases After Azar v....

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The U.S. Supreme Court’s 2019 decision in Azar v. Allina Health Services effectively curtailed the enforceability of certain Medicare policies established without notice-and-comment rulemaking. As a result, health care fraud...more

Foley & Lardner LLP

AseraCare FCA Ruling Is A Boon For Health Providers

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All hospice providers routinely should assess risk exposure under the False Claims Act — now with the benefit of the U.S. Court of Appeals for the Eleventh Circuit’s long-awaited decision in United States v. AseraCare Inc. ...more

Polsinelli

CMS Outlines New Standard for Challenging Medicare Payment Denials, Echoing Brand Memo on Force of Sub-Regulatory Guidance

Polsinelli on

On October 31, 2019, the Office of General Counsel for the U.S. Department of Health and Human Services (HHS) issued an important memo from Kelly M. Cleary, CMS Chief Legal Officer, and Brenna E. Jenny, Deputy General...more

Foley Hoag LLP - White Collar Law &...

Eleventh Circuit Holds Differences in Clinical Judgment Do Not Create FCA Liability for Hospice Provider

The Eleventh Circuit agreed with the trial court that the government must do more than present expert evidence that a physician’s clinical judgment was inaccurate to establish falsity under the False Claims Act. Nonetheless,...more

Hogan Lovells

Eleventh Circuit Confirms: Mere Difference of Opinion Between Physicians Does Not Establish Falsity Under the False Claims Act

Hogan Lovells on

More than two years after the Northern District of Alabama granted summary judgment in a False Claims Act (FCA) case in favor of AseraCare Inc., holding that “contradiction based on clinical judgment or opinion alone cannot...more

Jones Day

D.C. District Court Vacates 60-Day Medicare Advantage Overpayment Rule

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The Situation: In 2016, several Medicare Advantage ("MA") organizations challenged a 2014 final rule promulgated by the Center for Medicare Services ("CMS") that broadly subjected MA organizations to potential liability under...more

Akerman LLP - Health Law Rx

Florida Federal Court: Escobar Requires Reversal of $348 Million False Claims Act Jury Verdict

The United States District Court for the Middle District of Florida vacated a large jury verdict in a False Claims Act case against the owners and operators of nursing homes because the evidence did not satisfy the...more

Saul Ewing LLP

Middle District of Florida Vacates Massive Verdict Due to Plaintiff’s Failure to Prove Materiality and Scienter

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In United States ex rel. Angela Ruckh v. Salus Rehabilitation, LLC, et. al., No. 8:11-CV-1303-T-23TBM (M.D. Fla. Jan. 11, 2018), the Middle District of Florida vacated a jury award totaling nearly $350 million because the...more

Dorsey & Whitney LLP

Supreme Court Applies Escobar to Reinstate Implied Certification Suit Against Bank Based on Compliance With Fed Rules

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On Tuesday, February 21, 2017, the Supreme Court summarily vacated the judgment in Bishop v. Wells Fargo & Co. and remanded the case to the Second Circuit in light of the Court’s recent decision in Universal Health Servs. v....more

Dorsey & Whitney LLP

Eighth Circuit Vacates Relators’ FCA Settlement Recovery; Concludes that the FCA “Allows Relators to Recover a Percentage of the...

Dorsey & Whitney LLP on

The U.S. Court of Appeals for the Eighth Circuit recently vacated an award of settlement proceeds to relators of several related qui tam actions because the district court failed to make factual findings as to whether the...more

Dorsey & Whitney LLP

Sixth Circuit Reminds Government of its Burden to Prove Actual Damages in False Claims Act Litigation

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Last week, the United States Court of Appeals for the Sixth Circuit vacated a federal district court’s award of $657 Million for treble damages under the False Claims Act (“FCA”), restitution, and prejudgment interest. See...more

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