News & Analysis as of

Relators

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

First Circuit Tells False Claims Act Relators To “Put Up or Shut Up”

by Saul Ewing LLP on

The U.S. Court of Appeals for the First Circuit recently called summary judgment “the put up or shut up moment in litigation.” On January 30, 2017, the relators in U.S. ex rel. Booker v. Pfizer – a long-running False Claims...more

First Circuit Affirms Dismissal of FCA Off-Label Marketing Case for Failure to Meet 9(b) Particularity Requirement

by Ropes & Gray LLP on

In Lawton v. Takeda Pharmaceutical Co. et al., 842 F.3d 125 (1st Cir. 2016), the First Circuit affirmed the lower court’s dismissal of a False Claims Act (“FCA”) suit alleging a drug maker fraudulently marketed a product for...more

Failure to Plead Objective Falsity Dooms Cardiologist’s FCA Complaint

by Bass, Berry & Sims PLC on

A number of recent FCA decisions have grappled with the question of objective falsity, particularly in the context of FCA claims where the alleged falsity is premised on a lack of medical necessity in connection with the...more

Relax, Sixth Circuit Opinion Indicates Rule 9(b) Pleading Requirement Still Has Bite

by Bass, Berry & Sims PLC on

A recent Sixth Circuit opinion in U.S. ex rel. Hirt v. Walgreen Co. should come as welcome news for FCA defendants concerned about the implications of the Sixth Circuit’s application last year, for the first time, of a...more

First Circuit Holds That, for Original Source Exception to the False Claims Act’s Public Disclosure Bar to Apply, Information...

by Ropes & Gray LLP on

On June 30, 2016, the First Circuit addressed the kinds of information that a relator must provide to qualify as an original source to avoid dismissal under the False Claims Act’s (“FCA”) public disclosure bar. In United...more

Sixth Circuit Affirms that Broad Public Disclosure of Misconduct May Bar More Specific Allegations of Fraud Under False Claims...

by Ropes & Gray LLP on

In U.S. ex rel. Advocates for Basic Legal Equality, Inc. v. U.S. Bank, 816 F.3d 428 (2016), the Sixth Circuit affirmed the dismissal of a False Claims Act (“FCA”) suit against U.S. Bank based on the FCA’s public disclosure...more

Second Circuit Affirms Dismissal of Mortgage-Backed Securities New York State False Claims Act Case Against Wells Fargo

by Ropes & Gray LLP on

In New York ex rel. Jacobson v. Wells Fargo National Bank, N.A., 824 F.3d 308 (2d Cir. 2016), the Second Circuit affirmed the dismissal of a relator’s tax fraud-based claim against Wells Fargo under the New York False Claims...more

State Farm Fire and Casualty Co. v. United States ex rel. Rigsby

by Nexsen Pruet, PLLC on

The Supreme Court’s unanimous decision in State Farm Fire and Casualty Co. v. United States ex rel. Rigsby addresses sanctions for violating the seal provision of the False Claims Act (FCA). ...more

First Circuit Rejects Whistleblower’s Fraud on the FDA FCA Theory

by Ropes & Gray LLP on

On December 23, 2016, the First Circuit held that a relator under the federal False Claims Act (“FCA”) failed to plausibly plead that defendant medical device manufacturers caused the submission of false claims for...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

Supreme Court Rejects Dismissal Requirement for FCA Seal Violations

by Ropes & Gray LLP on

In State Farm Fire & Casualty Co. v. United States ex rel. Rigsby, the United States Supreme Court rejected State Farm’s argument that a relator’s violation of the automatic seal in a False Claims Act (“FCA”) case mandates...more

Supreme Court Rules on False Claims Act’s Seal Requirement

by McGuireWoods LLP on

In the midst of a False Claims Act (FCA) case, the relators have blatantly violated the FCA’s seal provision. Surely this will lead to dismissal, right? Wrong. On Tuesday, December 6, the Supreme Court unanimously...more

U.S. Supreme Court Rules That Seal Violations Do Not Require Dismissal of Qui Tam False Claims Act Suits

by K&L Gates LLP on

On Tuesday, the Supreme Court issued an anxiously anticipated False Claims Act (“FCA”) decision in State Farm Fire & Casualty Co. v. United States ex rel. Rigsby, holding that a violation of the statute’s seal requirement...more

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