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U.S. Health Care Industry Takes Note: U.S. Supreme Court 2023 Attention on False Claims Act

This Tuesday, April 18, 2023, the U.S. Supreme Court heard argument in U.S. v. SuperValu. SuperValu is the second – and more consequential – False Claims Act (FCA) case of the term....more

SEC approves executive officer incentive compensation clawback rules

On October 26, 2022, the SEC – by a 3-2 vote – approved final rules directing the NYSE, Nasdaq and other stock exchanges to adopt requirements for listed companies to develop and implement clawback, or recovery, policies that...more

What Recipients of Provider Relief Fund Payments Can Do to Mitigate Whistleblower Risk

We previously discussed how recipients of payments from the Provider Relief Fund (PRF) are at risk for allegations of fraud and specifically addressed how these recipients may become targets of False Claims Act (FCA)...more

Action Items for Recipients of Provider Relief Funds to Mitigate Risk Related to Fraud Allegations

In our last article, we discussed how recipients of payments from the Provider Relief Fund are at risk for allegations of fraud and specifically addressed how these recipients may become targets of False Claims Act (FCA)...more

Health Care Providers in Receipt of Provider Relief Funds: What You Need to Know and Do to Mitigate Fraud Risk

While the Provider Relief Fund payments sent to health care providers under the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) have provided a lifeline to compensate for increased expenses and lost revenues...more

What PPP Loan Recipients Can Do to Mitigate Whistleblower Risk

We previously discussed how recipients of larger PPP loans are at risk for allegations of fraud and specifically addressed how these recipients may become targets of False Claims Act (FCA) allegations. In addition, we...more

Action Items for Recipients of PPP Loans to Mitigate Risk Related to Fraud Allegations

In our last article, we discussed how recipients of larger PPP loans are at risk for allegations of fraud and specifically addressed how these recipients may become targets of False Claims Act (FCA) allegations, which can be...more

What Recipients of PPP Loans Need to Know and Do to Mitigate Fraud Risk

While the Payroll Protection Program (PPP) loans under the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) have given businesses a lifeline during these uncertain times, they also present a risk for fraud...more

What PE Firms Need to Know about Whistleblower Risk & How to Mitigate It

Private Equity firms face risk from whistleblowers within their portfolio companies. There are some industries that are more susceptible to whistleblower risk, such as health care, telecom and military contracts....more

What PE Firms Need to Know about their False Claims Act Risk

Private equity firms have recently become targets of False Claims Act (FCA) liability. This new risk exposure comes from portfolio companies that do business with the government, which necessarily exposes those portfolio...more

Emerging Themes in Financial Regulation 2020

Under the Senior Managers and Certification Regime (“SMCR”), firms are required to identify and report to the FCA any instances of disciplinary action taken in relation to conduct that would amount to a breach of one of the...more

FCA Defendants and Counsel Beware: New DOJ Guidance on FCA Cooperation Credit May Leave Too Much to Prosecutors’ Discretion

In recent weeks, the United States Department of Justice (“DOJ”) published guidance in the Justice Manual at Section 4-4.112 on how it will award cooperation credit to entities and individuals that are being investigated for...more

Supreme Court Resolves False Claims Act Circuit Split – Ruling gives individual relators the benefit of the government knowledge...

The False Claims Act (FCA) has two limitations periods: 1) within 6 years after the violation occurred, or 2) within “3 years after the date when facts material to the right of action are known or reasonably should have been...more

The Advice of Counsel Defense - Just How Far Does that Attorney-Client Privilege Waiver Go?

Following a recent federal court ruling, parties contemplating an advice of counsel defense must consider carefully the scope of the accompanying attorney-client privilege waiver. In United States ex rel. Lutz v. Berkeley...more

Effective Internal Compliance Programs

Effective compliance programs continue to gain importance. Across all industries, it is imperative that meaningful compliance programs are in place and that they are regularly assessed to account for new risks and changes in...more

Health Care FCA Decisions Applied to Criminal Case

False Claims Act (“FCA”) cases involving medical necessity continue to receive great attention. A March 7, 2017 opinion that overruled a jury’s criminal fraud conviction of a cardiologist demonstrates the broader implications...more

Statistical Sampling in FCA Cases Remains Uncertain, But the Government’s Absolute Veto Power Regarding Settlements Gets Affirmed

While all hoped the Fourth Circuit would finally provide some clarity regarding the use of statistical sampling in False Claims Act (FCA) cases, Valentine’s Day 2017 yielded some surprising events for those awaiting the...more

2016 Marks Third Highest Annual False Claims Act Recovery

Wednesday, the Department of Justice (DOJ) announced that 2016 was its third highest recovery year in False Claims Act (FCA) history. According to the press release, “DOJ obtained more than $4.7 billion in settlements and...more

CMS Final Rule Prohibits Pre-Dispute Arbitration Agreements with Nursing Home Residents

On September 28, 2016, the Centers for Medicare & Medicaid Services (“CMS”) released its first major rule affecting long-term care facilities since 1991. The rule lays out certain improvements in training and quality of care...more

7th Circuit Requires Objective Standards When Pleading Medical Necessity Under the FCA

The Seventh Circuit recently added an arrow to a False Claims Act (FCA) defendant's quiver by requiring relators to plead fraud allegations based on objective criteria pursuant to Fed. R. Civ. P. 9(b). This ruling will...more

The Changing Landscape of FCA Litigation for Healthcare Providers Due to Increased Civil Penalty Amounts

Since the late 1990s, the False Claims Act (“FCA”) has heavily affected the healthcare industry. In 2015, two-thirds of FCA lawsuits targeted healthcare entities, which paid out $1.9 billion. However, it is likely that this...more

High Court Imposes Important Limits on Implied False Certification Theory, but Theory Survives as a Basis for False Claims Act...

In a highly anticipated ruling, the Supreme Court imposed important limits on the implied certification theory of liability under the False Claims Act (FCA). The Court’s decision should go a long way toward limiting some more...more

Whistleblowers Suffer Another Implied Certification Theory Defeat — But Supreme Court Showdown Looms

Adding its voice to an issue soon to be argued before the Supreme Court, an Alabama federal court recently dismissed a False Claims Act (“FCA”) complaint, holding that complying with a federal disclosure regulation was not a...more

AseraCare Defeats DOJ False Claims Act Suit: Plaintiffs Must Present Evidence of an Objective Falsehood to Prove Falsity Under the...

On March 31, 2016, in United States v. AseraCare, Inc, No. 2:12-cv-245-KOB, 2016 U.S. Dist. LEXIS 42986 (N.D. Ala. Mar. 31, 2016), the district court granted summary judgment for AseraCare and emphasized that contradicting...more

If Uncle Sam Knows, Doesn’t Everyone? Seventh Circuit Affirms Dismissal Under Public Disclosure Bar, But Opens Door for...

On Feb. 29, the Seventh Circuit affirmed the dismissal of a False Claims Act (FCA) suit, holding the relator, Cause of Action, failed to establish subject matter jurisdiction given the FCA’s public disclosure bar (Cause of...more

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