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Introduction - Polsinelli proudly introduces the Health Care Fraud and Abuse 2023 Year in Review, a comprehensive examination of the evolving landscape surrounding the False Claims Act (“FCA”) and fraud & abuse enforcement...more
Supreme Court Justices Signal Skepticism of Qui Tam Constitutionality - On Friday, June 16, the US Supreme Court ruled that the US Department of Justice (DOJ) has the authority to dismiss qui tam suits brought under the...more
Because qui tam claims sound in fraud, under precedent and Rule 9(b) of the Federal Rules of Civil Procedure, relators are required to plead their claims with a heightened degree of specificity that many, having limited...more
On June 29, 2021, the Department of Justice (DOJ) announced a settlement with California skilled nursing facility operator Plum Healthcare Group LLC and facility Azalea Holdings LLC dba McKinley Park Care Center (Plum) to...more
On June 25, 2020, the United States Court of Appeals for the Eleventh Circuit reversed one of the most noted False Claims Act (FCA) decisions to have been handed down in a decade and reinstated most of a 2017 jury verdict...more
In late March, the United States Court of Appeals for the Ninth Circuit revived a whistleblower lawsuit under the False Claims Act (FCA) in which a former employee accused a healthcare provider of submitting reimbursement...more
Federal enforcers typically announce (formally as well as informally) work plans or focus areas for the upcoming year that can provide some guidance as to where providers might anticipate enforcement action and, where they...more
The Department of Justice (DOJ) recently announced a $10 million settlement in a False Claims Act (FCA) qui tam lawsuit against Southern SNF Management, Inc. (Southern) and related skilled nursing facilities. The lawsuit...more
In 2016, the United States Supreme Court issued its decision in Universal Health Servs. v. U.S. ex rel. Escobar which dealt, in part, with how the “materiality” requirement should be enforced in False Claims Act (“FCA”)...more
In United States ex rel. Angela Ruckh v. Salus Rehabilitation, LLC, et. al., No. 8:11-CV-1303-T-23TBM (M.D. Fla. Jan. 11, 2018), the Middle District of Florida vacated a jury award totaling nearly $350 million because the...more
False Claims Act cases often turn into battles of the experts. But only rarely does that battle turn into a rout. It did last week in a case out of the Eastern District of Virginia, United States ex rel. Ribik v. HCR...more
Bass, Berry & Sims is pleased to announce the release of its fifth annual Healthcare Fraud and Abuse Review 2016. The Review, compiled by the firm’s Healthcare Fraud Task Force, is an industry-leading guide to healthcare...more
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
On September 19 and 27, 2016, the US Department of Justice announced two False Claims Act settlements that required corporate executives to make substantial monetary payments to resolve their liability. How will director and...more
In a recent opinion, the Northern District of California allowed FCA claims to proceed against the CEO of a skilled nursing facility operator. John Orten, the whistleblower in the suit, was a former nursing home...more
Recently, South Carolina U.S. District Judge Joseph Anderson, Jr. issued an opinion in which he struggled with how to handle a non-intervened qui tam brought under the Federal False Claims Act (FCA). In his opinion, Judge...more
In a lawsuit brought under the False Claims Act ("FCA") a federal district judge in Florida recently rejected a defendant's challenge to a statistical sampling and extrapolation methodology advanced by a qui tam plaintiff's...more
That’s the upshot from U.S. ex rel. Absher v. Momence Meadows Nursing Center, Nos. 13-1886 & 13-1936 (Aug. 20, 2014), a recent decision from the Seventh Circuit (authored by Judge Manion) that addressed the worthless-services...more