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Ninth Circuit Denies Arbitration of a Relator’s FCA Claims

On September 11, 2017, in United States and State of Nevada ex rel. Welch v. My Left Foot Children’s Therapy, LLC, the Ninth Circuit held that an arbitration agreement between an employee-relator and her former employer was...more

First Circuit Finds that the Allegations in Escobar Satisfy the Supreme Court’s Materiality Requirements

The United States Supreme Court’s landmark decision in Escobar, which we have discussed previously, upheld the use of the implied certification theory where the implied certification of statutory/regulatory compliance is...more

DOJ Recovers More Than $4.7 Million from False Claims Cases in 2016

The United States Department of Justice has issued a press release announcing that it has recovered over $4.7 Billion from cases brought under the False Claims Act (FCA) during fiscal year 2016. Fiscal year 2016 ran from...more

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

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

Supreme Court Hands Down Opinion in Universal Health Services v. Escobar

The Supreme Court handed down its much-anticipated opinion in Universal Health Services, Inc. v. United States ex rel. Escobar et al. yesterday—a case addressing the viability of the implied certification theory in FCA...more

Supreme Court Hands Down Opinion in Universal Health Services v. Escobar

The Supreme Court handed down its much-anticipated opinion in Universal Health Services, Inc. v. United States ex rel. Escobar et al. yesterday—a case addressing the viability of the implied certification theory in FCA...more

Seventh Circuit Finds that Pharmacy Discount Programs Are Not Exempt from the Definition of “Usual and Customary”

Created in 2006, Medicare Part D is a government program that subsidizes the cost of prescription drugs to Medicare beneficiaries. The program is run through “Plan Sponsors” – private entities that receive a fixed monthly...more

6/3/2016  /  CMS , Kmart , Medicare Part D , Pharmacies , Qui Tam

Supreme Court Hears Arguments Regarding the Implied Certification Theory

On April 19, 2016, the United States Supreme Court heard oral arguments in the case of Universal Health Services v. U.S. ex rel. Escobar. The Universal Health Services case was brought by two relators whose child had been...more

Relators Recover Over $1 Billion in Non-Intervened Cases in Fiscal Year 2015

In fiscal year 2015, more than $1 Billion of the Government’s False Claims Act (FCA) recovery was derived from cases in which the Government declined to intervene. This significant recovery far exceeds the typical, annual...more

Third Circuit Ruling Reflects the Narrowed Scope of the Public Disclosure Bar under the Affordable Care Act

The public disclosure bar is a statutorily created hurdle that plaintiffs must cross to successfully maintain a False Claims Act suit. The principle was originally enacted to prevent individuals from filing “parasitic” False...more

Circuit Court Rules that Ambiguous Regulatory Requirements Cannot Give Rise to FCA Liability

A recent decision from the United States Court of Appeals for the District of Columbia Circuit evaluated whether a regulatory requirement was sufficiently ambiguous that it precluded a finding of liability under the False...more

Mitigating FCA Whistleblower Risk When Employees Leave

Over the past decade, efforts to enforce health care fraud regulations have been bolstered significantly with increased government funding and a dramatic increase in whistleblower claims filed under the False Claims Act’s qui...more

Federal Government Recovers $3.5 Billion from False Claims Cases in 2015

The United States Department of Justice has announced that it has recovered over $3.5 Billion from cases brought under the False Claims Act (FCA) in fiscal year 2015. This significant aggregate recovery is a slight decline...more

Defendants Obtain Summary Judgment In an FCA Action Because the Plaintiffs Failed to Identify Evidence of Specific False Claims

It is often stated that the sine qua non (the indispensable and essential action) of a violation of the False Claims Act (FCA) is the submission of a false or fraudulent claim. This principle has been recognized and cited in...more

Whistleblower Denied Recovery In FCA Case With $322 Million Settlement

A whistleblower was recently denied any portion of the Government’s recovery in a False Claims case despite the Government obtaining a settlement of approximately $322 million. The decision arose in the case of United States...more

Fifth Circuit Rejects FCA Case Based On Purported Improper Legal Billings

Although litigants frequently contend that the opposing party’s arguments are without factual or legal support, it is uncommon and unconventional for a litigant to contend that the opposing party has violated the FCA by...more

Persons Convicted for Participating in the Fraudulent Scheme Are Barred from Pursuing an FCA Action

The qui tam provisions of the False Claims Act (FCA) are broad in scope and permit a wide array of individuals to pursue FCA litigation as relators acting on behalf of the Government. However, the ability of individuals to...more

Relator’s Allegations from Prior Lawsuit Serves as Basis for Public Disclosure Bar Dismissal

In United States ex rel. Wilhelm v. Molina Healthcare of Florida, No. 12-24298, 2015 WL 5562313 (S.D. Fla. Sept. 22, 2015), the court provided further clarification on two frequently litigated issues of the FCA’s public...more

How Is a Relator’s Recovery in an FCA Settlement Taxed?

This rarely litigated question was presented to the Seventh Circuit in Patrick v. Commissioner of Internal Revenue, No. 14-2190, 2015 WL 5024985, — F.3d —- (Aug. 26, 2015). Previously, the First Circuit, in Fresenius Medical...more

Supreme Court Clarifies the First to File Bar

The first to file bar is a limitation on the rights of members of the public to commence certain litigation under the FCA. In essence, the first to file bar prevents a member of the public from commencing an action based...more

CMS Releases Data Regarding Hospital and Physician Utilization

CMS recently announced that it would be releasing Medicare hospital utilization and payment data, as well as physician and supplier utilization and payment data. This is the third year that the hospital data has been released...more

Supreme Court Rejects Application of Wartime Tolling to Civil False Claims Actions

The cost and risk associated with allegations under the FCA create a heightened importance on defining the scope of the claims that are at issue. Accordingly, the applicable statute of limitations is critical in determining...more

Sixth Circuit Affirms Sanctions for Frivolous and Retaliatory False Claims Act Suit

On May 1, 2015, in United States ex rel. Jacobs v. Lambda Res., Inc., No. 14-3705, 2015 WL 1948247 (6th Cir. May 1, 2015), the Sixth Circuit Court of Appeals affirmed the lower court’s award of sanctions against a relator and...more

Growing Use of Sampling in FCA Cases

In prior years, sampling has been at issue in FCA cases largely in the context of damages. Specifically, where there were allegations of a specific course of wrongful conduct that allegedly impacted large volumes of claims,...more

Illinois Court Rulings Vary on Consideration for Noncompetes

Recent decisions from the U.S. District Court for the Northern District of Illinois and the Illinois Appellate Court for the Third District (consisting of Bureau, Fulton, Grundy, Hancock, Henderson, Henry, Iroquois, Kankakee,...more

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