Last month in United States ex rel. Schutte, et al. v. SuperValu Inc. et al, the Supreme Court unanimously held (with Justice Thomas writing the opinion) that the False Claims Act’s (“FCA”) scienter element refers to a...more
7/13/2023
/ CIGNA ,
False Billing ,
False Claims Act (FCA) ,
Medicaid ,
Medicare ,
Personal Knowledge ,
Prescription Drugs ,
Reasonable Interpretations ,
Reckless Disregard ,
Relators ,
SCOTUS ,
US ex rel Tracy Schutte et al v SuperValu Inc et al ,
Whistleblowers
The Federal Trade Commission (“FTC”) on June 27 issued a proposed rule pursuant to which it would amend its Hart-Scott-Rodino Act (“HSR”) form and instructions and in so doing make major “top-to-bottom” changes for the first...more
7/7/2023
/ Comment Period ,
Department of Justice (DOJ) ,
Federal Trade Commission (FTC) ,
Hart-Scott-Rodino Act ,
Horizontal Mergers ,
Premerger Notifications ,
Proposed Amendments ,
Section 7 ,
Section 8 ,
Sherman Act ,
The Clayton Act
On the heels of the Sixth Circuit’s recent decision in Martin v. Hathaway, previously discussed on Health Law Observer, a critical issue in that case, i.e., the meaning of the term “remuneration” for purposes of the federal...more
The U.S. Supreme Court, in an 8-1 decision written by Justice Kagan, held on June 16 that the United States (“Government”), having initially chosen not to intervene in a False Claims Act (“FCA”) qui tam case, but having...more
In a unanimous decision Thrsday, the U.S. Supreme Court, in an opinion written by Justice Thomas, ruled that the False Claims Act’s (“FCA”) scienter element refers to a defendant’s knowledge and subjective beliefs — not to...more
As explained in prior posts, the Federal Trade Commission (“FTC”) filed suit in the U.S. District Court for the District of Columbia seeking to enjoin Louisiana Children’s Medical Center (“LCMC”) from continuing to integrate...more
In a prior blog post, we discussed U.S. ex. rel. Shannon Martin, M.D. v. Darren Hathaway, M.D. et al, a Sixth Circuit case involving the questions (1) whether a hospital’s decision not to hire an ophthalmologist (Dr. Martin)...more
Last Thursday, the Federal Trade Commission (“FTC”) took the step of filing suit in federal court asserting that parties to a hospital acquisition who had obtained a Certificate of Public Advantage (“COPA”) from their state...more
In previous posts we discussed Axon Enterprise, Inc. v. Federal Trade Commission, a case then being considered by the U.S. Supreme Court involving the question of whether parties seeking to undertake a transaction subject to...more
Two recently decided federal court cases hone in on the proper interpretation and application of three critical components of the Anti-Kickback Statute (“AKS”), namely:
•the requirement that a violation of the AKS must...more
4/17/2023
/ Affordable Care Act ,
Anti-Kickback Statute ,
Bribery ,
Causation ,
False Claims Act (FCA) ,
Federal Health Care Programs (FHCP) ,
Health Care Providers ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Patient Referrals ,
Qui Tam ,
Rebates ,
Remuneration
A recent U.S. District Court decision provides a good example of how federal courts will apply the public disclosure/original source rules in whistleblower cases alleging that health care providers violated the False Claims...more
Last Friday, Feb. 3, the U.S. Department of Justice (“DOJ”) issued a press release in which it announced the withdrawal of what it described as three “outdated” antitrust policy statements related to enforcement in health...more
In a prior post, we discussed the FTC’s recently-issued Proposed Rule that would, if finalized in its current form, and with only limited exceptions, prohibit employers from using non-compete clauses.
With respect the...more
As has been extensively reported, on January 5 the Federal Trade Commission (“FTC”) proposed a rule (the “Proposed Rule”) that would, with only limited exceptions, prohibit employers from using non-compete clauses. More...more
An important threshold question in qui tam cases under the False Claims Act is whether the relator-whistleblower is the original source of the information forming the basis for the claim. This is because qui tam actions under...more
Mergers between competitor hospitals in the same geographic market have been routinely scrutinized and often challenged by the Federal Trade Commission (“FTC”) and the U.S. Department of Justice (“DOJ”). Cross-market mergers...more
In a prior post, we discussed Axon v. Federal Trade Commission and its core question presented to the U.S. Supreme Court (Court): whether parties seeking to undertake a transaction subject to FTC review and seeking to...more
Supreme Court to Hear Oral Arguments in Axon Enterprises-
With the October 2022 term of the U.S. Supreme Court (“Court”) now underway, health care providers and others in the health care industry contemplating merger and...more
10/25/2022
/ Administrative Law Judge (ALJ) ,
American Hospital Association ,
Amicus Briefs ,
Antitrust Violations ,
Black Box ,
Constitutional Challenges ,
Department of Justice (DOJ) ,
Federal Rules of Civil Procedure ,
Federal Trade Commission (FTC) ,
Fifth Amendment ,
FTC Act ,
Hospitals ,
Oral Argument ,
PCAOB ,
Preliminary Injunctions ,
Regulatory Agencies ,
SCOTUS ,
Subject Matter Jurisdiction
In the first part of this article, we discussed the Federal Trade Commission’s (“FTC”) recently issued staff policy paper strongly urging states to avoid using Certificates of Public Advantage (“COPA”) which seek to immunize...more
Background-
Many states have enacted Certificate of Public Advantage (“COPA”) laws which seek to permit hospital mergers that might otherwise have been challenged by the Federal Trade Commission (“FTC”) and found to violate...more
In the recent hospital merger cases successfully challenged by the FTC (whether via the parties calling off the merger or losing in federal court), the merging parties have argued that, while the merger would not be likely to...more
We previously reported on several cases involving successful antitrust challenges to proposed hospital mergers involving Hackensack Meridian Health System and Englewood Hospital in Bergen County New Jersey; RWJ Barnabas...more
As reported in our June 13, 2022 blog post, the Federal Trade Commission (FTC) filed complaints on June 2 seeking to block the proposed merger of RWJBarnabas Health and Saint Peter’s Healthcare System in New Jersey and the...more
Just eight weeks after Hackensack Meridian Health System and Englewood Healthcare Foundation notified the Federal Trade Commission (“FTC”) that they were calling off their proposed merger following the Third Circuit Court of...more
The Office of Inspector General (“OIG”) in the Department of Health and Human Services has longstanding concerns regarding physician-owned entities that derive revenue from selling items ordered by their physician owners for...more