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Government Investigations Team Insights - July 2024

AGG’s Government Investigations Team Insights provides periodic updates covering legal and regulatory topics. Our team, which includes former federal prosecutors, SEC enforcement attorneys, and federal agency attorneys, has...more

Wave of the Future: Are AI and Data Mining the Next Generation of “Professional Whistleblowers”?

In the realm of False Claims Act (“FCA”) litigation, the emergence of artificial intelligence (“AI”) and data mining technologies has introduced both opportunities and complexities for defense strategies. Historically, qui...more

Government Investigations Team Insights - September 2023

AGG’s Government Investigations Team Insights provides periodic updates covering legal and regulatory topics. Our team, which includes former federal prosecutors, SEC enforcement attorneys, and federal agency attorneys, has...more

Gamesmanship No More: How the Government’s Dawdling Cut a False Claims Act Verdict in Half

After a substantial jury verdict following a lengthy trial, the United States Court of Appeals for the Fifth Circuit declined to accept the defendants’ invitation to throw out the government’s complaint in intervention as a...more

Government Investigations Team Insights - February 2023

AGG’s Government Investigations Team Insights provides periodic updates covering legal and regulatory topics. Our team, which includes former federal prosecutors, SEC enforcement attorneys, and federal agency attorneys, has...more

Does “Objective Reasonableness” Matter? Supreme Court Poised to Address Scienter Standard Under the False Claims Act

On January 13, 2023, the Supreme Court of the United States granted a writ of certiorari in two cases, United States ex rel. Schutte v. SuperValu Inc., 9 F.4th 455 (7th Cir. 2021) and United States ex rel. Proctor v. Safeway,...more

Government Investigations Team Insights - September 2022

AGG’s Government Investigations Team Insights provides periodic updates covering legal and regulatory topics. Our team, which includes former federal prosecutors, SEC enforcement attorneys, and federal agency attorneys, has...more

Eighth Circuit Says “But For” Causation Required in False Claims Act Case Based on an Alleged Anti-Kickback Violation

On July 26, 2022, the Eighth Circuit raised the bar for plaintiffs seeking to allege a violation of the False Claims Act (“FCA”) predicated on the Anti-Kickback Statute (“AKS”). Under this decision, the plaintiff must prove...more

COVID-19 Pet Boom Puts Spotlight on Veterinary Investment Opportunities

More than 23 million American households — nearly 1 in 5 nationwide — adopted a pet during the COVID-19 pandemic, according to the American Society for the Prevention of Cruelty to Animals (ASPCA). The increasing rates of pet...more

Georgia Supreme Court Sides With Nursing Home on Arbitration Issue Briefed by AGG Attorneys

Since 1925, Congress and the United States Supreme Court have recognized arbitration as a favored means of dispute resolution, offering a faster, more private, and less expensive alternative to the court systems....more

DOJ National Health Care Fraud Enforcement Action Results in Charges Involving Over $1.4 Billion in Alleged Losses

On Friday, September 17, 2021, the Department of Justice announced criminal charges against 138 defendants, consisting of 42 doctors, nurses, and other medical professionals in 31 federal districts across the United States....more

11th Circuit Confines Anti-Kickback Statute’s “One Purpose” Rule

On November 24, 2020, the Eleventh Circuit issued an opinion in U.S. v Shah (Case No. 19-12319), in which it disposed of the Anti-Kickback Statute’s (AKS or the “statute”) “one purpose” rule in certain circumstances. In this...more

2020 Government Investigations Team Insights - September 2020

AGG’s Government Investigations Team Insights provides periodic updates covering legal and regulatory topics. Our team, which includes former federal prosecutors, SEC enforcement attorneys, and federal agency attorneys, has...more

Attempts by Recruiters to Avoid Kickback Prosecutions Using the “Bona Fide Employee” Safe-Harbor Fail

On August 6, 2020, the United States Court of Appeals for the Sixth Circuit upheld the conviction of a patient recruiter in a Medicare kickback case, finding insufficient evidence to demonstrate that the recruiter was a “bona...more

Sixth Circuit Finds Public Disclosure Bar Precludes Suit Against Related Entity for Corporate-Wide Conduct

On June 3, 2020, the Sixth Circuit affirmed the dismissal of qui tam claims as barred, citing prior public disclosures. Holloway v. Heartland Hospice, Inc., Case No. 19-3646 (6th Cir. 2020)....more

Medicare Providers Receive No Interim Relief from Recoupment Despite “Colossal Backlog” of Appeals for Substantive Claims

On March 15, 2020, the Fifth Circuit issued an unpublished decision holding that a provider facing recoupment during the course of a Medicare claims appeal could not obtain federal question jurisdiction under 28 U.S.C. § 1331...more

White House Issues Executive Order on Regulatory Relief to Support Economic Recovery

On May 19, 2020, President Trump signed the Executive Order “Regulatory Relief to Support Economic Recovery.” The Order seeks “to combat the economic consequences of COVID-19” by directing government agencies to consider...more

“Worthless Services” Theory in False Claims Act Cases Dealt Another Blow

On April 15, 2020, the Eastern District of Pennsylvania issued a defense-favorable order, granting summary judgment in a False Claims Act case brought on a “worthless services” theory. U.S. ex rel. Jackson v. DePaul Health...more

5/13/2020  /  False Claims Act (FCA)

OIG Issues Proposed Rule on Civil Money Penalties

On April 21, 2020, the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG) issued a Proposed Rule amending civil money penalty (CMP) regulations. This Proposed Rule seeks to address three...more

Should You Keep the Medicare Provider Relief Funds and If So, What are the Compliance Risks?

On April 10, 2020, the Department of Health and Human Services (DHHS) released the first $30 billion portion of the $100 billion stimulus fund intended to provide financial relief to healthcare providers during the COVID-19...more

Ninth Circuit Rejects “Objective Falsehoods” Standard and Finds that False Certification of Medical Necessity May Give Rise to FCA...

On March 23, 2020, the Ninth Circuit rejected the conclusion that a mere difference in clinical judgment is insufficient to show “objective falsity.” In issuing this decision, Ninth Circuit joined the Fifth, Tenth, and Third...more

Vet Clinic Acquisitions Require Regulatory Diligence

In recent years, healthcare-focused private equity firms and start-ups are looking to minimize risk by investing in less regulated healthcare sectors. ...more

DOJ Announces $20 Million Settlement of False Claims Act Allegations Regarding Kickbacks and Unnecessary Spinal Surgeries

On October 28, 2019, the Department of Justice announced a $20.25 million settlement of False Claims Act (FCA) allegations. ...more

Georgia Supreme Court Declines to Address Constitutionality of Statute Governing Attorney Advertisements Using Nursing Home Survey...

On Monday June 24, 2019, the Georgia Supreme Court issued its opinion in Wilkes & McHugh, P.A. et al v. LTC Consulting, L.P. et al. LTC Consulting, L.P. and two affiliated entities, which operate three nursing homes in...more

Supreme Court Settles Debate Over Limitations Period for FCA Relators

On May 13, 2019, the Supreme Court handed down its decision in Cochise Consultancy, Inc. v. United States ex rel. Hunt, wherein it recognized a prolonged statute of limitations for a qui tam relator bringing an action under...more

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