Fraud False Claims Act (FCA)

Fraud is the making of false representations or engaging in deceptive behavior in order to unlawfully secure financial or personal gain. 
News & Analysis as of

U.S. v. AseraCare and the Standard of Falsity Under the False Claims Act

Prosecutors, defense attorneys and health care providers alike have been closely watching the U.S. v. AseraCare (No. 2:12-cv-00245) matter pending in the Northern District of Alabama. The AseraCare case relates to hospice...more

Principal Deputy Assistant Attorney General Mizer on Yates Memo: “No Partial Credit for Cooperation that Doesn’t Include...

Principal Deputy Assistant Attorney General Benjamin C. Mizer’s remarks at the 16th Pharmaceutical Compliance Congress and Best Practices Forum highlighted the Department of Justice’s “renewed commitment to ensuring that...more

The FCA Impact Of DOJ’s Increased Focus on Small Business

In 2014, the Small Business Administration reported that almost a quarter of approximately $367 billion of eligible funding for small business contracting, or roughly $91.7 billion, was awarded to small businesses as prime...more

OIG Targets Questionable Billing Practices for Ambulance Services

The Office of the Inspector General (“OIG”) pulled no punches in a recent report on Medicare Part B billing for ambulance transports. The September release presented a case for increased scrutiny, pointing out that Medicare...more

Insurance Recovery Law - October 2015

Unfair Trade Practices Exclusion Doesn't Cover Consumer Protection Suits - Why it matters: An unfair trade practices clause did not bar coverage for a policyholder's subsidiary, an Illinois federal court ruled, ordering...more

How Employers Can Combat Timecard Fraud And Employee Wage Theft

There is nothing so central to wage-hour laws than the sacred domain of “hours worked.” The concept is simple: employees record the time they spend working, and from this data employers generate labor budgets and employee pay...more

Judge Dismisses FCA Claim Against City of Chicago; Concludes that “Subsequent Nonperformance of a Future Commitment” Was Not a...

On September 16, 2015, the U.S. District Court for the Northern District of Chicago dismissed a False Claims Act (FCA) case against the City of Chicago, because the qui tam complaint did not satisfy the relevant pleading...more

New Justice Department Directive Underscores Focus on Individuals—and Importance of Cooperation—in False Claims Act Investigations

In a recent memorandum issued to Main Justice litigating components and United States Attorney’s offices nationwide, Deputy Attorney General Sally Quillan Yates emphasized that “fighting corporate fraud and other misconduct”...more

Whistleblower Filed Too Early & Too Late for Share of $322M SCAN Scam Recovery

During his days as a data encounter manager at SCAN, Jim suspected the company had been double-billing Medicare and Medicaid for years. He expressed his concerns within SCAN. When he refused a job reassignment, he was fired....more

Fourth Circuit Affirms Dismissal of FCA Complaint Alleging Contracting Fraud

In an unpublished decision issued on Thursday, August 13, 2015, the Fourth Circuit Court of Appeals reemphasized Federal Rule of Civil Procedure 9(b)’s “stringent particularity requirement” when it affirmed a lower court’s...more

D.C. Circuit Reaffirms Validity of Attorney-Client Privilege and Work Product Protection in Internal Investigations

On August 11, 2015, in United States ex rel. Barko v. Halliburton et al., No. 14-5319, slip op. (D.C. Cir. Aug. 11, 2015), the U.S. Court of Appeals for the D.C. Circuit issued an important opinion vacating another series of...more

July Whistleblower Digest | News Your CCO Needs to Know

This month’s digest features whistleblower collections for a corporate insider who helped solve a fraud case and for five individuals who uncovered a False Claims Act violation. This digest also features a section of news...more

DOJ Hires Compliance Counsel to Aid in Charging Decisions

In today’s robust enforcement climate, most companies have taken at least the first steps towards establishing a formal corporate compliance program. The mere existence of such a program, however, will not by itself protect a...more

Ninth Circuit Eases Ability for Whistleblowers to Bring Qui Tam Actions

In an important development under False Claims Act (“FCA”) case law, the U.S. Court of Appeals for the Ninth Circuit has expressly abrogated former precedent limiting the ability of whistleblowers to recover funds reimbursed...more

Reverse Payment Settlements as Basis for False Claims Act Liability

The threat of federal False Claims Act (“FCA”) liability based on the failure to promptly return overpayments is a relatively new phenomenon, but it is receiving a lot of attention. In 2009, Congress enacted the Fraud...more

Ninth Circuit Bars Qui Tam Relator’s Whistleblower Recovery in False Claims Act Suit Over Conviction

On July 16, the U.S. Court of Appeals for the Ninth Circuit affirmed a district court’s dismissal of a qui tam relator from a False Claims Act suit, holding that the False Claims Act requires dismissal of a relator convicted...more

Wisconsin Repeals State False Claims Act

On July 12, 2015, the state of Wisconsin passed a budget that, along with many expected cuts, additions, and tweaks, unexpectedly repealed Wisconsin’s False Claims for Medical Assistance Act—the state’s version of the federal...more

Felony Conviction Bars Whistleblower from Pursuing Qui Tam Case

A relator convicted of criminal conduct is precluded from sharing in related FCA recoveries, irrespective of degree of culpability. On July 16, a US Court of Appeals for the Ninth Circuit panel upheld the dismissal from...more

Ninth Circuit Concludes that Conviction Precludes Relator Recovery

The Ninth Circuit last week held that pursuant to 31 U.S.C. 3730(d)(3) of the False Claims Act (“FCA”), a qui tam relator who is convicted of conduct giving rise to the fraud that is the subject of the FCA lawsuit must be...more

The Fourth Circuit Expands the Implied Certification Theory to Anti-Retaliation Claims

On January 8, 2015, the Fourth Circuit determined that, amid a circuit split, the “implied certification” theory of liability under the False Claims Act (“FCA”) was viable in the Fourth Circuit. United States v. Triple...more

You Can’t Cover Up Fraud with TARP Funds: US Government Sues Bank President’s Estate

On July 1, 2015, the United States for the District of Columbia sued the estate and trusts of the late Layton P. Stuart – the former owner of One Financial Corporation and its subsidiary One Bank & Trust– and the trust’s...more

Dialysis Provider Settles Whistleblower Lawsuit for $450 Million

The Department of Justice and dialysis provider DaVita Healthcare Partners recently finalized a $450 million agreement settling claims that the company intentionally inflated Medicare billings. The parties had filed a joint...more

D.C. Circuit Interprets the First-to-File Rule Narrowly

A decision this week from the D.C. Circuit shed light on three important issues. United States ex rel. Heath v. AT&T, Inc., No. 14-7094 (D.C. Cir. June 23, 2015). In 2008, the appellant, Todd Heath, filed an FCA qui tam...more

The Federal and Nevada False Claims Acts

Contractors are no strangers to the courts of justice. Litigation between contractors and owners frequently occurs when a project does not get completed on time or the work does not comply with the Contract Documents. The...more

Provider Alleges Retaliatory Use of Medicare Payment Suspension

A federal court has ordered discovery regarding the circumstances of a Medicare payment suspension by CMS only one week after failed settlement negotiations between a cardiology practice and the Department of Justice (DOJ) to...more

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