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Health Care Providers Scienter

Bass, Berry & Sims PLC

Second Circuit Clarifies Anti-Kickback Statute’s Scienter Requirement

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On March 12, the U.S. Court of Appeals for the Second Circuit issued an important decision that sheds light on the test for determining scienter under the federal Anti-Kickback Statute (AKS). The Second Circuit reasoned that...more

American Conference Institute (ACI)

[Event] 11th Annual Advanced Forum on False Claims and Qui Tam Enforcement - January 23rd - 24th, New York, NY

Hosted by American Conference Institute, the 11th Annual Advanced Forum on False Claims and Qui Tam Enforcement returns for another exciting year for lively discussions on FCA enforcement including the ramifications of two...more

Cozen O'Connor

Whistleblower Watch - A quarterly update on FCA Enforcement and Qui Tam Litigation

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Summer 2023- Whistleblower Watch is a comprehensive source for all False Claims Act (FCA) news and information. Every quarter, Cozen O’Connor will provide in-house counsel and compliance professionals with a summary of the...more

BCLP

U.S. Health Care Industry: Risk Mitigation Tips in the Post-Supervalu FCA Landscape

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As we predicted, the Supreme Court held that a business could be exposed to substantial damages under the False Claims Act (FCA) if it incorrectly applies ambiguous rules or regulations. The unanimity of the opinion—which we...more

Husch Blackwell LLP

SCOTUS Signals Likely Reversal in SuperValu, Arguments Reflect Concerns over Application to Other FCA Cases

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On April 18, 2023, the United States Supreme Court heard oral argument in two consolidated cases that have the potential to upend False Claims Act (FCA) litigation. Oral argument on both sides and questioning from the...more

Venable LLP

Is 2023 the "Year" of the False Claims Act? For the Courts, Congress, and Contractors, It Just Might Be

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One hundred sixty years ago, Congress passed the False Claims Act (FCA) in response to widespread fraud committed against the United States government during the Civil War. Known as the "Lincoln Law," the FCA was originally...more

Hogan Lovells

The False Claims Act Guide: 2022 and the road ahead - Supreme Court to review knowledge standard

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In recent years, federal courts have been grappling with the scienter element of the False Claims Act (FCA), including how to assess scienter when a statutory, contractual, or regulatory obligation could be interpreted in...more

Akerman LLP - Health Law Rx

Mind Games: SCOTUS to Rule on what “Knowing” Means under the False Claims Act

What does it mean to “knowingly” or “recklessly” violate the law when that law consists of highly complex and ever-changing regulations, which may be open to interpretation? The U.S. Supreme Court recently agreed to review...more

A&O Shearman

California District Court Grants Motion To Dismiss With Prejudice Putative Securities Class Action Against Healthcare Company,...

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On June 9, 2022, Judge David O. Carter of the United States District Court for the Central District of California granted a motion to dismiss a putative class action lawsuit alleging violations of Sections 10(b) and 20(a) of...more

Health Care Compliance Association (HCCA)

The emerging battle over 'objective reasonableness' in False Claims Act cases

CT Magazine (June 2022) - The Medicare and Medicaid programs are exceedingly complex, and navigating the myriad statutes, regulations, rules, and guidance presents significant challenges for all healthcare providers and...more

Jones Day

Fourth Circuit Limits Who Can Act "Knowingly" Under False Claims Act

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Health care industry participants frequently operate under nuanced legal frameworks that apply to the receipt of government funds. A breach of these regulations can open the door to draconian liability under the FCA even when...more

Manatt, Phelps & Phillips, LLP

The Fourth Circuit Raises the Bar for Proving Scienter Under the False Claims Act

On January 25, 2022, the U.S. Court of Appeals for the Fourth Circuit issued an important opinion for companies trying to navigate the complex statutory scheme in heavily regulated areas like Medicare and Medicaid....more

Miles & Stockbridge P.C.

The Fourth Circuit Grants Potential Relief from FCA Claims to Medical Providers Struggling to Decipher Medicare Requirements

Medical providers often are left confused by the incredibly complex statutory and regulatory body of law implemented by the Centers for Medicare and Medicaid Services (CMS). Without further administrative guidance, providers...more

Holland & Knight LLP

Healthcare Law Update: October 2021

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Kathryn Isted In Harbor Healthcare System, L.P. v. United States, 5 F.4th 593 (5th Cir. 2021), the court of appeals ruled that the district court abused its discretion in refusing to exercise its equitable jurisdiction over a...more

American Conference Institute (ACI)

[Virtual Event] 8th Annual Advanced Forum on False Claims and Qui Tam Enforcement - March 24th - 25th, 8:15 am - 4:45 pm...

THE ONLY EVENT WHERE YOU'LL HEAR FROM Government, In-house Counsel, The Judiciary, the Defense & Relator’s Bar - ACI’s 8th Annual Advanced Forum on False Claims and Qui Tam Enforcement will address the underlying...more

Mintz - Health Care Viewpoints

Third Circuit Rejects AseraCare’s “Objective Falsity” Requirement, Allows Scrutiny of Medical Opinions in Hospice False Claims Act...

Last week, the Third Circuit joined several other appellate courts in finding that medical opinions related to medical necessity of hospice services can be subject to scrutiny and found to be “false” for purposes of proving a...more

Foley & Lardner LLP

Third Circuit Creates Budding Circuit Split in United States v. Care Alternatives, Ruling That “Objective Falsity” Is Not Required...

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The United States Court of Appeals for the Third Circuit ruled last week that whistleblower relators need not show “objective falsity” to prove their claims, and that a dispute among physician experts about a clinical...more

Akin Gump Strauss Hauer & Feld LLP

11th Circuit’s Decision in AseraCare: Important in Determining When Clinical Judgment Regarding Medical Necessity Can Result in an...

• Reasonable disagreement among clinicians, by itself, does not result in a false claim. • Clinical judgment must be objectively false to constitute an FCA violation. • A clinical judgment may only be objectively false...more

Troutman Pepper

Eleventh Circuit Says Difference Of Opinion Does Not Establish Falsity In False Claims Act Case

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On September 9, in a setback for AseraCare but an overall win for hospice providers, the Eleventh Circuit affirmed a Northern District of Alabama decision to grant a new trial in a False Claims Act (FCA) case against...more

Cadwalader, Wickersham & Taft LLP

Untimely Physician Certifications for Medicare Home Care Claims—Arguably a Technicality—Vulnerable to False Claims Act...

On June 11, 2018, the United States Court of Appeals for the Sixth Circuit sustained a complaint against a home health care agency alleging that the agency had violated the False Claims Act (the “FCA”) by submitting numerous...more

A&O Shearman

Southern District Of New York Dismissed Exchange Act Claims Against Healthcare Company Regarding Surgical Gowns

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On March 30, 2018, the United States District Court for the Southern District of New York dismissed a class action against Halyard Health, Inc. (“Halyard”) and its executives, along with Kimberly-Clark Corporation...more

Sheppard Mullin Richter & Hampton LLP

Escobar’s Demanding Materiality Standard Nixes $350 Million Verdict Against Florida Nursing Facility

A Florida federal court threw out a $350 million jury verdict against a nursing facility, citing the Supreme Court’s landmark decision in Universal Health Services, Inc. v. United States ex rel. Escobar. The court explained...more

Jones Day

False Claims Act: Circuit Court Questionably Construes Scienter Requirement

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The U.S. Court of Appeals for the Eleventh Circuit recently issued an opinion addressing the False Claims Act's intent requirement. U.S. ex rel. Phalp v. Lincare Holdings, Inc., No. 16-10532, ___ F.3d ___ (11th Cir. May 26,...more

Bass, Berry & Sims PLC

Deeper Dive: Meeting the FCA’s Intent Requirement

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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 will...more

Holland & Knight LLP

Reasonable Interpretation of Ambiguous Regulation May Not Preclude False Claims Act Liability

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A recent appellate court ruling governing all federal court cases in Florida, Georgia and Alabama establishes that a defendant in a False Claims Act (FCA) case cannot rely on a defense that there was no intent to defraud the...more

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