False Claims Act Medicare

The False Claims Act is a United States federal law originally enacted in 1863 to recover fraudulently acquired funds from government contractors.  In 1986, The False Claims Act was amended to increase... more +
The False Claims Act is a United States federal law originally enacted in 1863 to recover fraudulently acquired funds from government contractors.  In 1986, The False Claims Act was amended to increase whistleblower incentives and to permit the government to seek treble damages for allegations of fraud against the government less -
News & Analysis as of

Worthless Services Investigations and Settlements: The Enforcement Trend Continues

In recent years, state and federal governments have shown their willingness to criminally pursue skilled nursing home owners and operators for allegedly administering “worthless” or substandard quality of care to their...more

Fox Hollow Technologies Agrees to Settle False Claims Act Allegations

The United States Department of Justice recently announced that ev3 Inc., a company that recently acquired Fox Hollow Technologies, agreed to pay a $1.25 million penalty to settle accusations that Fox Hollow had committed...more

CMS Rule on Medicare Overpayments? Don’t Hold Your Breath

Since the Center for Medicare & Medicaid Services proposed a rule three years ago suggesting that providers could be liable for returning Medicare overpayments going back ten years, providers have been anxiously awaiting a...more

Narrowing Of FCA Public Disclosure Bar Continues

On Feb. 25, 2015, the Sixth Circuit became the latest federal court of appeals to weigh in on the scope of the False Claims Act’s public disclosure bar in its decision in United States ex rel. Whipple v. Chattanooga-Hamilton...more

February Whistleblower News Digest: Ethical Culture Builds Foundation of Your Whistleblower Hotline Program

Given the popularity of our FCPA Compliance Digest and the abundance of whistleblower-related news, here are the top whistleblower stories for February. Read on to the end for access to an exclusive resource to help you build...more

Hospice Provider Pays $4 Million to Settle Allegations of Fraudulent Billing

Good Shepherd Hospice, Inc., a for-profit hospice providing services in Oklahoma, Missouri, Kansas, and Texas (“Good Shepherd”), has agreed to pay $4 million to the U.S. government to settle allegations that it submitted...more

Device Manufacturer Settles False Claims Act Allegations with DOJ for $1.25 Million

The Department of Justice (DOJ) recently announced that ev3 Inc. (which acquired Fox Hollow Technologies, Inc. (“Fox Hollow”), a medical device manufacturer, in late 2007) agreed to pay $1.25 million to resolve allegations...more

No False Claim Despite Violation of Licensing Law and Medicare Conditions of Participation

Last week a federal court in Florida granted a radiology practice’s motion for judgment in its favor in a False Claims Act case, despite these formidable obstacles: (1) the practice had billed Medicare for services performed...more

Health Headlines: Also in the News - January 2015 #3

ALSO IN THE NEWS - HHS Publishes Goals on Alternative Payment Models with Continued Focus on Quality – In its continued efforts to base Medicare payments on quality over quantity, this morning HHS made public its goal...more

Catching Up on the False Claims Act

From a corporate risk perspective, if your company is in the financial industry, healthcare, or defense industry, your greatest legal and compliance risk has to be the False Claims Act....more

First Circuit Reaffirms FCA’s “First-to-File” Bar as a Broad Jurisdictional Limit

In early December 2014, the United States Court of Appeals for the First Circuit reaffirmed that circuit’s broad interpretation of the False Claims Act’s “first-to-file” bar, 31 U.S.C. § 3730(b)(5), in United States ex rel....more

Pharmacy Qui Tam Based On U&C Price Billing Survives Motion to Dismiss

Once again, a pharmacy employee has filed a qui tam involving a drug discount program, alleging that the failure of the pharmacy to use the discounted pricing as the “usual and customary” price in Medicaid and Medicare Part D...more

HHS to Audit Hospital Reporting of GPO Payments: GAO Report Suggests Further Scrutiny of GPO Shareback with Hospitals

On November 24, 2014, the Government Accountability Office (“GAO”) published a report examining the contracting practices and funding structures of health care group purchasing organizations (“GPOs”) and their potential...more

Blog: DOJ’s Record Year for FCA Recoveries Includes $2.3 Billion for Health Care Fraud

The Department of Justice (DOJ) announced this week that it recovered a record $5.69 billion in civil False Claims Act (FCA) settlements during fiscal year 2014. This recovery included $2.3 billion for FCA cases involving...more

Eleventh Circuit Limits Scope of FCA Whistleblower Suit

Late last month, a three-judge panel of the Eleventh Circuit Court of Appeals reinstated portions of a former executive’s False Claims Act (“FCA”) whistleblower action against Health Management Associates Inc. (“HMA”),...more

Government turns up the heat with the False Claims Act – 5 action steps for healthcare providers

Forbes magazine has dubbed 2014 “The Year of the Whistleblower.” For healthcare providers, this designation has translated into millions of dollars in fines and penalties and the initiation of criminal investigations. ...more

DOJ Criminal Division Renews Efforts to Investigate Whistleblower Allegations

The Department of Justice (DOJ) has signaled a heightened effort to bring criminal prosecutors into the loop regarding False Claims Act referrals and other whistleblower complaints. In recent remarks at a conference comprised...more

SRDP No Longer New Wine

More than four years after the Centers for Medicare & Medicaid Services' (CMS) issuance of the Stark Self-Referral Disclosure Protocol (SRDP), it's time to assess the results. The SRDP was designed by Congress to resolve...more

Blurring the Lines between False Claims Act Litigation and Putative Federal Malpractice Law: The DOJ Quietly Invokes “Worthless...

On October 10, 2014, the United States Department of Justice (“DOJ”) announced a civil settlement agreement (the “Settlement”) with Extendicare Heath Services, Inc. and its subsidiary Progress Step Corporation (collectively,...more

Provider of Physical, Speech, and Occupational Therapy Services Agrees to $38,000,000 False Claims Act Settlement

As announced in an recent press release, Extended Care Health Services, Inc. (“Extendicare”), an operator of skilled nursing facilities, and its subsidiary Progressive Step Corporation (“Pro Step”), a provider of physical,...more

Seventh Circuit Reaffirms Worthlessness of Worthless Services Cases

In August the Seventh Circuit expressed its view that so-called “worthless services” cases don’t state a claim under the False Claims Act. Last Friday the court reaffirmed its view by refusing to rehear the case en banc....more

Whistleblower Goes It Alone to Secure $5 Million Settlement under False Claims Act

The potential success of a whistleblower lawsuit filed under the False Claims Act (FCA) is significantly reduced when the government fails to intervene because such cases are often assumed to lack merit. However, a plaintiff...more

Department of Justice Files First False Claims Act Lawsuit Against Physician-Owned Distributorship

On Sept. 8, 2014, the United States Department of Justice (DOJ) filed a 98-page civil complaint alleging that investment returns, paid to a Michigan spinal surgeon and other physicians by a spinal implant company partially...more

Whistleblower Defendant Blows Whistle on Whistleblower

Antonio Saidiani filed a whistleblower suit alleging that NextCare urgent centers and CEO Dr. Shufeldt had collected tens of millions of dollars in false Medicare claims. Antonio was in a position to know because he was that...more

OIG Warns Pharma Its Copayment Coupons May Aid Crime

Brand name drugs cost a lot. So to make them more attractive, drug manufacturers issue coupons for discounts on the copayment portion of the price. They work the same as the dollar-off coupons offered by cereal manufacturers....more

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