News & Analysis as of

Relators

FCA Deeper Dive: Original Sources under the FCA’s Public Disclosure Bar

by Bass, Berry & Sims PLC on

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...more

Free Parking, Yes, But No Stark Law Claim

by Ruder Ware on

A federal court recently dealt a victory to a health care provider over whistleblower allegations that free parking and valet service at a medical office building violated the Stark Law and the Anti-Kickback Statute....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

Deeper Dive: Meeting the FCA’s Intent Requirement

by Bass, Berry & Sims PLC on

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

A Striking EHR Settlement: The DOJ pursues an EHR Vendor for "Causing the Submission" of False EHR Incentive Payment Claims

by Bass, Berry & Sims PLC on

On May 31, 2017, the U.S. Department of Justice (DOJ) announced a $155 million settlement with eClinical Works (ECW), a nationally-known electronic health records (EHR) software vendor. The settlement arises out of a lawsuit,...more

FCA Deeper Dive: Escobar and Its Aftermath – Part II

by Bass, Berry & Sims PLC on

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

FCA Claim of “Phantom Students” Won’t Continue to Haunt College, Says Ninth Circuit

by Saul Ewing LLP on

The for-profit education company Kaplan, Inc. recently scored a win when the Court of Appeals for the Ninth Circuit affirmed Kaplan’s summary judgment victory in a decade-long False Claims Act suit. This case shows that while...more

FCA Deeper Dive: Pleading the Alleged Fraud Scheme

by Bass, Berry & Sims PLC on

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 are...more

Third Circuit’s Gift to Qui Tam Defendants

by Faegre Baker Daniels on

It’s so brief—just eleven words in a 23-page, single-spaced opinion—that you could easily overlook it, but the Third Circuit’s recent opinion cites the government’s nonintervention in a qui tam case as evidence supporting...more

FCA Issues to Watch: FCA Claims Concerning Physician Compensation

by Bass, Berry & Sims PLC on

Physician employment arrangements with hospitals have remained a significant area of regulatory scrutiny in recent months with the announcement of several high profile settlements and decisions in key FCA cases involving...more

Guest Post – Justice for Patriots’ Fans

by Reed Smith on

This guest post by Andrew C. Bernasconi, of Counsel at Reed Smith, is about a hopeful development in a False Claims Act case we’ve already blogged about once. The previous post queried, what happens when a FCA relator,...more

Judge Has No Interest in DOJ’s Statement of Interest

by Faegre Baker Daniels on

In yet another demonstration of the benefits of lifetime tenure, a federal judge in Florida has told the Department of Justice to take a hike. It happened when the DOJ asked for permission to submit a “statement of interest”...more

FCA Deeper Dive: Rule 9(b) and Pleading Actual Claims

by Bass, Berry & Sims PLC on

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 are...more

Healthcare Fraud and Abuse Review 2016

by Bass, Berry & Sims PLC on

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

Second Circuit Affirms Dismissal of FCA Cases

by Jones Day on

The Second Circuit affirmed the dismissal of two False Claims Act ("FCA") cases brought by private relators against insurance and other companies based on the alleged failure to reimburse the Centers for Medicare & Medicaid...more

No “Relaxed” Pleading Standards for False Claims Act Relators, Says Sixth Circuit

by Saul Ewing LLP on

In United States ex rel. Hirt v. Walgreen Company, the United States Court of Appeals for the Sixth Circuit recently affirmed the dismissal of a pharmacy owner’s False Claims Act (“FCA”) lawsuit because he failed to plead his...more

Agape Take Two - 4th Circuit Court of Appeals Rules on FCA Statistical Sampling Case

by Poyner Spruill LLP on

Last May, we reported on a False Claims Act (FCA) case pending in the 4th Circuit Court of Appeals regarding a claim brought in the U.S. District Court in South Carolina against a network of 24 nursing home providers...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

Court Examines Standard for Approval of Settlement of Qui Tam Over a Relator’s Objection

by Dorsey & Whitney LLP on

The False Claims Act (FCA) allows plaintiffs/relators to bring qui tam actions, in which the government may then elect to intervene. The FCA also provides that “[t]he Government may settle a [qui tam] action with the...more

Fourth Circuit Declines to Review Issue of Statistical Sampling Use in FCA Case

by King & Spalding on

On February 14, 2017, the U.S. Court of Appeals for the Fourth Circuit issued a long-awaited opinion in the case U.S. ex rel. Michaels v. Agape Senior Community, Inc. et al. (case number 15-2145 and 15-2147). In this FCA...more

DOJ Intervenes in Risk Adjustment FCA Case

by Bass, Berry & Sims PLC on

Recently, the DOJ intervened in one of several currently pending qui tam cases involving Medicare Advantage (MA) and the Risk Adjustment process used to determine the amount of payments to Medicare Advantage Organizations...more

Improvidently Granted Appeal Statistically Yields Sampling Uncertainty

by BakerHostetler on

The Fourth Circuit Court of Appeals agreed in 2015 to hear an interlocutory appeal of a district court’s decision to prohibit a qui tam relator from using statistical sampling to prove liability and damages in a False Claims...more

Proof by Proxy in FCA Suits? District Court Says It Depends

by Morgan Lewis on

Admissibility of statistical sampling to prove liability in FCA suit is fact dependent. In a February 14, 2017 decision, the Fourth Circuit declined to rule on the question of whether statistical sampling can be used to...more

Fourth Circuit Takes a Pass on Statistical Sampling, Finds DOJ's Settlement Veto Authority Unreviewable

by Bass, Berry & Sims PLC on

After granting the relators’ petition for an interlocutory review of the district court’s rejection of the use of statistical sampling to establish FCA liability, the Fourth Circuit ultimately declined to reach that issue in...more

Fourth Circuit Sidesteps Statistical Sampling Issue

by Saul Ewing LLP on

In a decision issued yesterday, the United States Court of Appeals for the Fourth Circuit dismissed an appeal that would have addressed one of the most pressing unresolved issues in False Claims Act jurisprudence: whether...more

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