Medicare, False Claims Act | JD Supra Law News

Jury Ruled in Tuomey Healthcare Retrial that the Hospital Violated the Stark Law and False Claims Act

by King & Spalding on 5/17/2013

On May 8, 2013, a jury concluded that Tuomey Healthcare System, Inc. (Tuomey), a community hospital in Sumter, S.C., violated the Stark law for allegedly improper compensation arrangements in 2005 between the hospital and 19...more

Sixth Circuit Applies Strict Precondition of Payment Requirement to Reverse $11.1 Million FCA Judgment

by Nicholas Linder, Kirsten Mayer, Arefa Shakeel | Ropes & Gray LLP on 5/15/2013

The U.S. Court of Appeals for the Sixth Circuit, in United States ex rel. Hobbs v. MedQuest Associates, Inc., 711 F.3d 707 (6th Cir. April 1, 2013), recently reversed an $11.1 million False Claims Act (“FCA”) judgment,...more

Sixth Circuit in MedQuest: No FCA Liability for Violation of Medicare Conditions of Participation Without Violation of Conditions...

by Calvin Marshall | Chambliss, Bahner & Stophel, P.C. on 4/26/2013

On April 1, 2013, the U.S. Court of Appeals for the Sixth Circuit overturned an $11.1 million False Claims Act (FCA) judgment by the U.S. District Court for the Middle District of Tennessee against MedQuest Associates, Inc.,...more

Sixth Circuit Holds Physician Supervision and Enrollment Issues Are Not Conditions of Payment for Purposes of FCA Liability

by Darby C. Allen, B. Scott McBride | BakerHostetler on 4/23/2013

The Sixth Circuit Court of Appeals recently issued a decision overturning an $11.1 million False Claims Act (FCA) verdict against MedQuest Associates, Inc. (MedQuest) for submitting claims to Medicare in violation of the...more

Courts of Appeals Continue to Limit the Government’s Aggressive False Claims Act Theories

by Chelsey Hadfield, Ty Howard, Jack Selden | Bradley Arant Boult Cummings LLP on 4/23/2013

This spring saw two significant victories for health care providers in the federal courts of appeals. In both cases, the courts rejected an aggressive government theory under the False Claims Act (FCA), the first related to...more

Court Rules That Supervision and Enrollment Issues Don't Give Rise to False Claims Act Liability

by Kristen Cilento Carter | Ober|Kaler on 4/19/2013

Following the ever-growing progeny of cases holding that Medicare conditions of participation do not give rise to False Claims Act (FCA) liability, the United States Court of Appeals for the Sixth Circuit overturned an $11...more

Seven Tips to Protect Your Facility from a False Claims Act Lawsuit

by Amy McCracken | Duane Morris LLP on 4/8/2013

The False Claims Act is a federal law that imposes liability on persons and companies who make false claims for payment to the federal government. Many states have similar laws. The Act encourages whistleblowers to file suit...more

Sixth Circuit Rules No FCA Liability Based on Violation of Medicare Requirements

by Ellyn L. Sternfield | Mintz Levin - Health Law on 4/4/2013

On April 1st, the Sixth Circuit reversed an $11.1 million dollar summary judgment finding entered against MedQuest Associates, a diagnostic testing company. In its opinion, the Sixth Circuit found that violation of two...more

Deferred Prosecution Agreements: How an Effective Compliance Program Can Help You Plan for the Unpredictable

by John S. Linehan, Gina L. Simms | Ober|Kaler on 2/27/2013

During the past several years, prosecutors have increasingly used Deferred Prosecution Agreements (DPAs) against corporations in enforcing white collar criminal statutes. DPAs have enabled companies to avoid the costs and...more

Health Care Enforcement in 2012: A Year in Review

by Hope Foster, Samantha Kingsbury, Tracy Miner, Jessica Sergi, Stephanie Willis | Mintz Levin - Health Law on 2/26/2013

Last year was another busy year in health care fraud enforcement. In 2012, the Office of Inspector General for the Department of Health and Human Services (HHS-OIG) reported total expected recoveries of $6.9 billion from all...more

The Healthcare Industry And The Voluntary Disclosure Process

by Michael Volkov on 2/21/2013

It is always important to consider how different parts of the government handle voluntary disclosures. The FCPA enforcement initiative has been largely the result of the voluntary disclosure process, and the government...more

HHS and DOJ Release Annual Report on Health Care Fraud and Abuse Control Program, Which Recovered $4.2 Billion in FY 2012

by King & Spalding on 2/20/2013

On February 13, 2013, the U.S. Department of Health and Human Services (HHS) and the Department of Justice (DOJ) released their annual report for fiscal year 2012 on the Health Care Fraud and Abuse Control Program (HCFAC). ...more

Judge Approves Two-Year Delayed Prosecution of WakeMed

by King & Spalding on 2/14/2013

A Federal district court judge issued a February 8, 2013 order granting a delayed prosecution against Raleigh, NC-based WakeMed Health and Hospitals for allegedly submitting false inpatient bills to Medicare. The...more

Major New Jersey Health System Pays $12.6 Million To Settle False Claims Act Suit Alleging Physician Kickback Scheme

by Henry E. Hockeimer, Jr., Evan Krick, Dee Spagnuolo | Ballard Spahr LLP on 1/31/2013

Federal prosecutors recently announced a $12.6 million False Claims Act (FCA) settlement with a major New Jersey health system to resolve allegations that the system paid outside physicians in order to increase referrals....more

DOJ Recovers Up To $48 Million in False Claim Act Case Resulting From Whistleblower Report

by Sigal Mandelker, Massiel Pedreira | Proskauer - Whistleblowing & Retaliation on 1/24/2013

In yet another large recovery for the DOJ, on December 6, 2012, DFB Pharmaceuticals, and its subsidiary, Healthpoint Ltd., agreed as part of a settlement to pay up to $48 million to resolve allegations that Healthpoint caused...more

Second Circuit Declares Off-Label Promotion Ban Unconstitutional: Implications for False Claims Act Defendants

by Aileen Mcgill | Patterson Belknap Webb & Tyler LLP on 1/17/2013

On December 3, 2012, the United States Court of Appeals for the Second Circuit held that the First Amendment protects pharmaceutical companies who truthfully promote the lawful, off-label use of prescription drugs from...more

Florida-Based Company Settles False Claims Act Lawsuit For $15.3 Million

by Marta Moakley | XpertHR - Partnered with LexisNexis on 1/10/2013

The Department of Justice (DOJ) has announced that Jacksonville, Florida-based American Sleep Medicine LLC has settled allegations that it fraudulently billed Medicare, TRICARE (the health care program for uniformed...more

Qui Tam Case Study: Dismissal Based On Whistleblower’s Lack Of Standing

by Walter Tache | Carlton Fields on 1/7/2013

Qui tam lawsuits — cases brought by private whistleblowers on behalf of the government — represent a growing risk for businesses that contract with the government or make claims as part of a government program, such as...more

Navigating the Provider Self-Disclosure Protocol

by Barbara Taylor | Sheppard Mullin Richter & Hampton LLP on 12/29/2012

Providers can voluntarily disclose potential fraud with respect to Federal health care programs — Medicare, Medicaid, and potentially private insurers to the extent Federal or state funds are involved — by following the...more

Sixth Circuit Overturns $82.6 Million Medicare Fraud Judgment

by McDermott Will & Emery on 11/5/2012

Based on the recent decision in United States, ex rel. Williams v. Renal Care Group, Inc., medical service providers in the Sixth Circuit that have established separate corporate entities to maximize corporate profits and...more

Sixth Circuit Overturns False Claims Act Judgment Based on Ambiguous Regulations Where Provider Made Reasonable Attempts to Comply

by Christopher A. Myers, David I. Schneider | Holland & Knight LLP on 10/31/2012

The U.S. Court of Appeals for the Sixth Circuit has reversed a summary judgment that held a business liable for violating the False Claims Act by using regulatory loopholes to maximize profits under the Medicare program. In...more

Federal Appeals Court Rules Healthcare Company Can’t Be Punished Under FCA for Maximizing Profits

by Ashley Adams on 10/25/2012

At Ashley D. Adams, PLC, we have a well-established track record of success in false claim cases that can make a difference. For both organization defending against false claims charges and individuals pursuing qui tam...more

Physicians and Pharmacies Must Be Aware of the Dangers and Potential Penalties Associated with Importing Prescription Drugs

by Fuerst Ittleman David & Joseph, PL on 10/11/2012

Introduction - As the price of healthcare continues to increase, healthcare practitioners have become more innovative and creative in their attempts to keep costs affordable for their patients. One technique which has...more

Healthcare Prosecutions for Failures to Return Overpayments

by Michael Volkov on 10/11/2012

Sometimes the deck is stacked against you. No matter what you do and how hard you try, you will lose. In the healthcare area, hospitals, doctors and other service providers have to feel the frustration when it comes...more

Healthcare Companies Need to Update Compliance

by Michael Volkov on 9/21/2012

The Supreme Court’s decision upholding most of the Affordable Care Act increased compliance responsibilities for healthcare companies. The ACA amended the False Claims Act (FCA), which was amended in 2009 in the Fraud...more

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Medicare › False Claims Act