False Claims Act (FCA) Whistleblowers

News & Analysis as of

The False Claims Act’s Anti-Retaliation Provision Protects Employees Who Engage in Efforts to Stop Violations By Their...

In Carlson v. DynCorp, the United States Court of Appeals for the Fourth Circuit addressed 2009 and 2010 amendments to the False Claims Act (“FCA”) that broadened the scope of its anti-retaliation protection for...more

7th Cir. Demands Objective Standards in Whistleblower Complaint

On September 1 the Seventh Circuit affirmed dismissal of three of a whistleblower’s four fraud allegations against a mental health clinic, ruling that the allegations were based on the whistleblower’s subjective judgment...more

Strangest Regulatory Interpretation of the Month

The Massachusetts federal district court is hands-down winner of the August award for strangest regulatory interpretation of the month. The interpretation came in the context of denial of Omnicare’s summary judgment...more

Seventh Circuit Clarifies “Heightened” Pleading Standard for Fraud Claims under the False Claims Act

A recent decision of the United States Court of Appeals for the Seventh Circuit addressed the standard that courts should use to decide whether a whistleblower plaintiff has adequately pleaded that a defendant committed fraud...more

Fourth Circuit Issues Ruling Interpreting False Claim Act Whistleblower Amendments

The Fourth Circuit recently issued a decision interpreting the anti-retaliation provision of the False Claims Act (FCA). The decision provides important clarification about how courts may interpret 2009 and 2010 amendments...more

Healthcare Compliance: Juggling Risk Mitigation Strategies

Healthcare organizations – ranging from physician practice groups to large, multi-state hospital systems – face a variety of risks, including fraud and abuse, as well as HIPAA privacy issues. Starting from a baseline risk...more

60-Day Overpayment FCA Enforcement Action Results in $2.95 Million Settlement

On August 23, 2016, a New York hospital system settled False Claims Act (FCA) allegations that it violated the 60-day overpayment rule by improperly retaining Medicaid overpayments. The whistleblower alleged that three of the...more

Whistleblower’s Claim Survives Dismissal and Death

The Energizer Bunny has nothing on the whistleblower claim of Robert Cunningham. Here’s what’s happened since Robert files his qui tam action against Millennium Labs back in 2009: the government declined to intervene; seven...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

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

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

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

Your daily dose of financial news - The Brief – 7.28.16

A pair of whistleblowers is seeking discovery-related sanctions against Wells Fargo for allegedly concealing “crucial evidence” for their False Claims Act claims over fees added to government-backed mortgages....more

Check Up on Healthcare Fraud Prosecutions

Chief compliance officers face an overwhelming level of risk in the healthcare sector. I do not mean to belittle the risks of corruption, AML, sanctions and other risks typically associated with global companies. Healthcare...more

Aveta And The Use Of Confidential Info In FCA Cases

In a recent case in the District of Puerto Rico, United States ex rel. Valdez v. Aveta Inc., et al., No. 15-cv-01140-CCC (D.P.R.), the former president of Puerto Rican-based managed health care provider Aveta Inc., Jose...more

When Inside Knowledge Is a Handicap to a Whistleblower

Here’s a riddle: The whistleblower is a former employee of the defendant, with inside knowledge of the operations at the heart of his qui tam suit. How can that inside knowledge be a handicap in pressing his claim? A June...more

Supreme Court Issues Long-Awaited Key Decision on False Claims Act

The U.S. Supreme Court (SCOTUS) issued a decision today in a case that has important implications for healthcare providers and other organizations that bill the U.S. government for goods or services. (Universal Health...more

Client Alert: Top Ten Things the Health Care Industry Should Know about Civil Investigative Demands

Civil Investigative Demands, or CIDs, are a favorite tool of the Federal Government to get information from all types of providers who bill federal payors. This information could form the basis of a civil or criminal...more

The False Claims Act and the Yates Memorandum

Acting Associate Attorney General Bill Baer discussed the application of the "Yates Memorandum" in the context of civil False Claims Act ("FCA") matters in a speech on June 9, 2016 at the ABA's 11th National Institution on...more

Good News on the Horizon? FCA Reform Could Signal Relief for Health Care Providers

Good news may be in sight for businesses and health care providers. On April 28, 2016, the House Judiciary Committee's Subcommittee on the Constitution and Civil Justice once again considered potential updates to the...more

District Court Holds that Interest in Protecting Whistleblowers under the False Claims Act Can Outweigh Companies’ Confidentiality...

A magistrate judge in the Northern District of Illinois recently dismissed a company’s breach-of-contract counterclaim against a whistleblower for violating the company’s privacy policy and confidentiality agreement....more

Court Throws Out Counterclaim That Whistleblower Divulged Confidential Information

A federal judge recently dismissed a company’s counterclaim that it brought against a whistleblower for violating the company’s privacy policy and a confidentiality agreement by providing the government with confidential...more

California Employment Law Notes - May 2016

Employee Who Needed To Assist Disabled Son Could Proceed With "Associational Disability Discrimination" Claim - Castro-Ramirez v. Dependable Highway Express, Inc., 246 Cal. App. 4th 180 (2016) - Luis...more

Escobar Oral Arguments: Justices Imply Outcome – False Claims Act Implied Certification May Survive

The U.S. Supreme Court recently held oral arguments in the case of Universal Health Services, Inc. v. U.S. ex rel. Escobar, No. 15-7, which is set to decide the viability of implied certification under the FCA. As discussed...more

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