News & Analysis as of

Qui Tam Medicare

Early Victory: Judge Dismisses Qui Tam Suit Against UnitedHealthcare

by Arnall Golden Gregory LLP on

On October 5, 2017, in United States of America ex rel. Swoben v. Scan Health Plan, et al. (“Swoben”), Judge John F. Walter of the United States District Court for the Central District of California granted United Health...more

Newly Announced Chicago Health Care Fraud Unit Could Signal a Change in the Northern District of Illinois’s Health Care...

by Ropes & Gray LLP on

On July 18, 2017, Acting U.S. Attorney for the Northern District of Illinois, Joel R. Levin, announced the creation of a dedicated criminal Health Care Fraud Unit. The five prosecutor unit will operate within the Criminal...more

Healthcare Law Update: September 2017

by Holland & Knight LLP on

OIG Advisory Opinions - Manufacturer's Free Replacement of Spoiled Pharmaceutical Products Authorized - On Aug. 25, 2017, the U.S. Department of Health and Human Services' (HHS) Office of Inspector General (OIG)...more

Second Circuit Accepts Appeal of False Claims Act First-To-File Issues

by Farrell Fritz, P.C. on

The Second Circuit recently agreed to accept an interlocutory appeal to decide the question whether a violation of the False Claims Act’s “first-to-file” rule compels dismissal of the complaint or whether it can be cured by...more

Sixth Circuit: Technical Physician Signature Deficiencies not "Material" to Reimbursement Claims

by Jones Day on

The District Court for the Middle District of Tennessee held on June 22, 2017, that the timing requirements related to a physician's certification of need for home health services were not "material" to the Centers for...more

Client Alert: Feds Shine a Light on Medicare Advantage Plans and Physicians Related to Risk Adjustment Practices

Although the sufficiency of medical records documentation supporting beneficiary diagnoses for Medicare Advantage (MA) risk adjustment has been on the OIG’s work plan since 2013, the Department of Justice has upped the ante...more

Court Overreaches in Requiring Medical Necessity Determination by Labs

by Jones Day on

On June 9, 2017, the U.S. District Court for the District of Columbia denied a motion to dismiss brought by a laboratory in U.S. ex rel. Groat v. Boston Heart Diagnostics Corp., 2017 WL 2533341. Part of the grounds for...more

Court Puts the Brakes on Whistleblower's FCA Parking Claims

by Baker Ober Health Law on

The Department of Justice (DOJ) reports that, in fiscal year 2016 ending September 30, it obtained more than $4.7 billion in settlements and judgments from civil cases involving fraud and false claims. More than half of this...more

DOJ’s New Healthcare Fraud Target—Medicare Advantage Insurers

by Blank Rome LLP on

The government continues to seek ways to rein in healthcare costs. Now it has set its sights on the Medicare Advantage Program. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private...more

The Enforcement Risks for Medicare Advantage Plans Continue: A New False Claims Act Settlement in Florida

Recent activities of the Department of Justice (“DOJ”) and Qui Tam whistleblowers reveal that Medicare Advantage Plans remain at the forefront of investigations for violations of the federal False Claim Act (“FCA”) for...more

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

by Holland & Knight LLP on

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

Third Circuit joins other circuits in enforcing Escobar's strict materiality requirement

by DLA Piper on

The Third Circuit has affirmed the district court's dismissal of a relator's claims in United States ex rel. Petratos, et al. v. Genentech Inc, et al, a False Claims Act (FCA) case alleging that the defendants-appellees...more

The Siege Continues: The Justice Department is Investigating Four Additional Medicare Advantage Plans

In our prior blog post, we reported that, at the request of the federal Department of Justice, the FCA qui tam whistleblower lawsuit in the case of United States ex rel Benjamin Poehling v. United HealthGroup, Inc., et. al....more

Mintz Levin Health Care Qui Tam Update - Recently Unsealed Whistleblower Cases: March 2017

by Mintz Levin on

Trends & Analysis - ..This issue looks at 18 health care–related qui tam cases that were unsealed in whole or in part in late October through November 2016. ..The cases identified were filed in federal district courts...more

Mintz Levin Health Care Qui Tam Update: Recently Unsealed Whistleblower Cases

Featured Unsealed Cases United States ex rel. Thomas v. Best Choice Home Health Care Agency, Inc., No. 2:13-cv-02209 (D. Kan.) - Complaint Filed: May 6, 2013 - Complaint Unsealed: October 24, 2016...more

False Claims Act Alert: Fourth Circuit Punts on Sampling and Extrapolation

by Hogan Lovells on

Tuesday, the Fourth Circuit Court of Appeals ruled in the interlocutory appeal in United States ex rel. Michaels v. Agape Senior Community, Inc.. In an opinion considering two significant questions arising under the qui tam...more

Healthcare Law Update: December 2016

by Holland & Knight LLP on

Prompt Payment Discounts Not an Anti-Kickback Statute Violation - In United States of Am. et al. ex rel. Ruscher v. Omnicare, No. 15-20629, 2016 WL 6407128 (5th Cir. Oct. 28, 2016), the court of appeals affirmed summary...more

The Difference between Expecting Referrals & Inducing Them

by Faegre Baker Daniels on

A new Fifth Circuit opinion explains the difference between offering a benefit in order to induce a Medicare referral and offering it in the expectation of a referral. The difference is important because the former is a...more

Lincoln’s Law Becomes Even More Absurd When Applied to the Health Care Industry

by Ruder Ware on

When Congress originally passed the False Claims Act (31 USC §§ 3729-3733), no one had the health care system in mind. The False Claims Act was also commonly referred to as the “Lincoln Law”. The original law was focused on...more

Recent Settlements Demonstrate the Reach and Versatility of the FCA

by Bass, Berry & Sims PLC on

In recent years, civil enforcement efforts involving the FCA have grown significantly. Today, the FCA impacts a vast array of businesses, as it is commonly used to redress false claims for government funds involving...more

Florida Federal District Court Dismisses Plaintiff’s Qui Tam Action Against Hospice Providers

by King & Spalding on

On September 22, 2016, the United States District Court for the Middle District of Florida granted defendant hospice providers’ motions to dismiss plaintiff-relator’s claims under the False Claims Act, Florida’s False Claims...more

Can a Relator Plead with Particularity without Alleging that a Patient’s Bill was Submitted to the Government?

by McGuireWoods LLP on

The Seventh Circuit says yes. Early this month, the Seventh Circuit reversed and remanded a district court’s holding that a qui tam Relator failed to properly plead a False Claims Act suit where the Complaint did not allege...more

US Supreme Court False Claims Act Decision in Escobar Has Significant Implications for Contractors

by Pepper Hamilton LLP on

On June 16, 2016, the U.S. Supreme Court ruled in the matter of Universal Health Services, Inc. v. United States ex rel. Escobar, 136 S. Ct. 1989 (2016), changing the legal landscape for False Claims Act qui tam claims...more

Health Care Matters, Summer 2016

by JAMS on

Special Masters in Health Care Antitrust Merger Cases: Resolving the Conflicting Interests - One of the most challenging aspects of antitrust cases in the health care field is the rich mixture of public interest...more

Texas Diagnostic Imaging Service Settles FCA Allegations for $3.5 Million; Whistle-Blower to Receive $596,700

by Dorsey & Whitney LLP on

A recent settlement illustrates the substantial recovery available to whistle-blowers under the FCA’s qui tam provisions. Those provisions allow a qui tam plaintiff to receive typically between 15 percent and 25 percent of...more

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