We are pleased to bring you our 12th annual Healthcare Fraud & Abuse Review. Our Review provides comprehensive coverage of the most significant civil and criminal enforcement issues facing healthcare providers. Each year, we...more
2/27/2024
/ Anti-Kickback Statute ,
CARES Act ,
Coronavirus/COVID-19 ,
Department of Justice (DOJ) ,
Enforcement Actions ,
False Claims Act (FCA) ,
Fraud and Abuse ,
Health Care Providers ,
Healthcare ,
Healthcare Fraud ,
Kickbacks ,
Medical Devices ,
Pharmaceutical Industry ,
Physicians ,
Prescription Drugs ,
Qui Tam ,
Settlement ,
Stark Law ,
Telemedicine
Below are noteworthy False Claims Act (FCA) decisions from the third quarter of 2023.
The main issues in the cases are:
Materiality. The Fourth Circuit held that a pharmacist’s efforts to falsify patient eligibility...more
10/19/2023
/ Anti-Kickback Statute ,
Causation ,
Class Action ,
Damages ,
False Claims Act (FCA) ,
Fraud and Abuse ,
Fraudulent Procurement ,
Healthcare ,
Investigations ,
Jury Verdicts ,
Kickbacks ,
Materiality ,
Medicaid ,
Relators ,
Statute of Limitations
If you are part of a heavily regulated—or heavily litigated—industry, at some point, you or your company are likely to receive a third-party subpoena.
This post offers guidance on how to respond to this common discovery...more
In this post, we summarize noteworthy False Claims Act (FCA) decisions so far from 2023.
Each of the three circuit court opinions discussed here ruled in favor of the defendants on different aspects of the FCA: the Sixth...more
5/1/2023
/ Anti-Kickback Statute ,
Causation ,
Dismissals ,
Enforcement Actions ,
False Claims Act (FCA) ,
Fraud ,
Government Investigations ,
Health Care Providers ,
Materiality ,
Medicare ,
Pharmaceutical Industry ,
Public Disclosure Bar ,
Qui Tam ,
Relators ,
Remuneration
Having previously examined the falsity, materiality, and scienter elements of the False Claims Act (FCA) in our FCA Fundamentals series, we now turn to what damages can arise from violations of the False Claims Act...more
There have been several significant rulings on various provisions of the False Claims Act (FCA) in the first quarter of this year, which we highlight in this post.
Government Dismissal Authority -
To start the year, in...more
Each year, the Department of Justice (DOJ) recovers millions of dollars through False Claims Act (FCA) settlements, and 2021 was no exception. Some of the most sizeable or otherwise noteworthy settlements from 2021 were with...more
1/24/2022
/ Anti-Kickback Statute ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Justice (DOJ) ,
Fair Market Value ,
False Claims Act (FCA) ,
Fraud ,
Hospitals ,
Kickbacks ,
Medicare Advantage ,
Qui Tam ,
Settlement ,
Stark Law
The False Claims Act (FCA) prohibits employers from retaliating against whistleblowers who report FCA violations. 31 U.S.C. § 3730(h). To plead a claim under this anti-retaliation provision of the FCA, an employee must show...more
10/12/2021
/ Employees ,
Employer Liability Issues ,
Employment Litigation ,
Enforcement Actions ,
False Claims Act (FCA) ,
Health Care Providers ,
Healthcare Fraud ,
Hospitals ,
Pharmaceutical Industry ,
Retaliation ,
Whistleblowers
The United States District Court for the Northern District of Alabama recently ordered that a relator’s qui tam lawsuit must be unsealed upon the case’s voluntary dismissal, denying the relator’s request to maintain the...more
Earlier this month the Northern District of California unsealed a criminal complaint filed against the president of a medical technology company, charging him with one count of conspiracy to commit healthcare fraud and one...more
Government Settles with Several Entities, Individuals -
Last week, Vanguard Healthcare and related entities reached a settlement with the Department of Justice (DOJ) for the stated amount of more than $18 million to settle...more
3/7/2019
/ Billing ,
Corporate Integrity Agreement ,
Department of Justice (DOJ) ,
Elder Care ,
False Claims Act (FCA) ,
Health Care Providers ,
Long Term Care Facilities ,
Medicaid ,
Medicare ,
Nursing Homes ,
Quality of Care Standards ,
Settlement Agreements ,
Worthless Services Claims
On December 11, 2018, the United States announced that it has elected to intervene in a False Claims Act (FCA) lawsuit filed against Sutter Health and its affiliated entity Palo Alto Medical Foundation (PAMF) alleging that...more
1/18/2019
/ Centers for Medicare & Medicaid Services (CMS) ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Health Care Providers ,
Healthcare Fraud ,
Medicare Advantage ,
Overpayment ,
Qui Tam ,
Relators ,
Risk Adjustment Formula ,
Whistleblowers