Many health care providers treating senior patients rely on Medicare reimbursement and undertake significant measures to ensure proper billing and compliant practices. However, providers across the country may soon be subject...more
12/10/2020
/ American Medical Association ,
Centers for Medicare & Medicaid Services (CMS) ,
False Claims Act (FCA) ,
Health Care Providers ,
Hospice ,
Medicare ,
Petition for Review ,
PHRMA ,
Physician Medicare Reimbursements ,
Qui Tam ,
SCOTUS
On October 26, 2020, the Small Business Administration (SBA) published notice in the federal register that it is seeking approval from the government’s Office of Management and Budget (OMB) to release two new forms (Form 3509...more
11/13/2020
/ Business Interruption ,
CARES Act ,
Coronavirus/COVID-19 ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Health Care Providers ,
Liquidity ,
Loan Forgiveness ,
OMB ,
Paycheck Protection Program (PPP) ,
Questionnaires ,
SBA
While recent federal funding has provided a lifeline for some companies, accepting government assistance under the CARES Act also carries significant legal, political and reputational risks for recipients. Loans are the tip...more
Following the Eleventh Circuit’s and Third Circuit’s recent rulings in United States v. AseraCare and United States v. Care Alternatives, respectively, the Ninth Circuit Court of Appeals has now also addressed the question of...more
The COVID-19 virus crush is upon us at this moment. Like in 2008 with TARP, the government has invited businesses around the country to apply for CARES Act relief to help survive this pandemic...more
4/9/2020
/ Affiliated-Business Arrangements ,
Board of Directors ,
Business Interruption ,
CARES Act ,
Coronavirus/COVID-19 ,
Economic Injury Disaster Loans ,
False Claims Act (FCA) ,
Federal Loans ,
Financial Stimulus ,
Health Insurance ,
Paycheck Protection Program (PPP) ,
Payroll Taxes ,
Relief Measures ,
SBA ,
SBA Lending Programs ,
Shareholders ,
Small Business ,
Stocks ,
Tax Relief
In times of crisis, there are heroes, villains, victims, and everyone in between. Amidst the COVID-19 crisis, many valiant efforts are under immense time pressure—to care for the ill, to protect the vulnerable, to find and...more
The United States Court of Appeals for the Third Circuit ruled last week that whistleblower relators need not show “objective falsity” to prove their claims, and that a dispute among physician experts about a clinical...more
3/12/2020
/ False Claims Act (FCA) ,
Health Care Providers ,
Hospice ,
Insurance Fraud ,
Life Sciences ,
Medicare ,
Objective Falsity ,
Physicians ,
Professional Liability ,
Qui Tam ,
Relators ,
Scienter ,
Triable Issue of Fact ,
Whistleblowers
Federal enforcers typically announce (formally as well as informally) work plans or focus areas for the upcoming year that can provide some guidance as to where providers might anticipate enforcement action and, where they...more
All hospice providers routinely should assess risk exposure under the False Claims Act — now with the benefit of the U.S. Court of Appeals for the Eleventh Circuit’s long-awaited decision in United States v. AseraCare Inc. ...more
2/4/2020
/ Appeals ,
Evidence ,
False Claims Act (FCA) ,
Health Care Providers ,
Hospice ,
Jury Verdicts ,
Medical Experts ,
Medical Records ,
Medicare ,
Objective Falsity ,
Physicians ,
Summary Judgment ,
Terminal Illness Treatments ,
Trial Court Orders ,
Vacated
Although a whistleblowing employee typically cannot release fraud claims against her employer brought on behalf of the United States under the False Claims Act (FCA), courts have demonstrated a willingness to enforce properly...more
10/9/2019
/ Anti-Retaliation Provisions ,
False Claims Act (FCA) ,
Fraud ,
Health Care Providers ,
Qui Tam ,
Release of Claims ,
Retaliation ,
Severance Agreements ,
Waiver of Liability ,
Waivers ,
Whistleblower Protection Policies ,
Whistleblowers
Tuesday’s ruling by the United States Court of Appeals for the Eleventh Circuit in United States v. AseraCare is a win for hospice and other health care providers who have long argued that a mere difference of clinical...more
Health care providers, government contractors, and others who receive money from the federal government are at greater risk of suit under the False Claims Act (FCA), 31 U.S.C. §§ 3729 et seq., following the Supreme Court’s...more
5/31/2019
/ Appeals ,
Cause of Action Accrual ,
Cochise Consultancy Inc v United States ex rel Hunt ,
Dismissals ,
False Claims Act (FCA) ,
Federal Contractors ,
Intervenors ,
Limitation Periods ,
Qui Tam ,
Reaffirmation ,
Relators ,
Reversal ,
SCOTUS ,
Statute of Limitations
In a memo leaked last year (the Granston Memo), the U.S. Department of Justice (DOJ) instructed its prosecutors to more seriously consider dismissing meritless whistleblower False Claims Act (FCA) cases when it is in the...more
On May 7, 2019, the Department of Justice (DOJ) released guidance for civil prosecutors in determining how to assess cooperation in False Claims Act (FCA) cases. See DOJ’s press release and its revised manual. In particular,...more
If one appellant has its way, the False Claims Act (FCA) would be gutted by way of its qui tam provisions struck down as unconstitutional by the United States Supreme Court. That is the position taken by Intermountain Health...more
5/15/2019
/ Appeals ,
Appointments Clause ,
Article III ,
Constitutional Challenges ,
False Claims Act (FCA) ,
Federal Rules of Civil Procedure ,
Hospitals ,
Petition for Writ of Certiorari ,
Physician Medicare Reimbursements ,
Physicians ,
Qui Tam ,
Relators ,
Reversal
Effective immediately, a settlement agreement or a judgment with the government must set forth the specific amount of restitution, remediation of property, or monies paid to come into compliance with any law violated, for...more
In January 2018, the Department of Justice (DOJ) issued two memoranda that, taken together, may usher in a new era of False Claims Act (FCA) enforcement in the health care industry. The first memorandum, dated January 10,...more
3/12/2018
/ Administrative Procedure Act ,
Anti-Kickback Statute ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Justice (DOJ) ,
Enforcement Guidance ,
False Claims Act (FCA) ,
Health Care Providers ,
Healthcare Fraud ,
Judgment on the Merits ,
Materiality ,
Medicare ,
Memorandum of Guidance ,
National Security ,
Public Comment ,
Qui Tam ,
Universal Health Services Inc v United States ex rel Escobar
The new tax law changed the deductibility of settlements with government agencies in some circumstances thereby increasing the cost to companies to settle these cases. The deduction arose from the section in the Internal...more
2/19/2018
/ Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Financial Industry Regulatory Authority (FINRA) ,
Fines ,
Internal Revenue Code (IRC) ,
IRS ,
Reporting Requirements ,
Section 162(f) ,
Securities and Exchange Commission (SEC) ,
Settlement Agreements ,
Tax Cuts and Jobs Act ,
Tax Deductions
On January 25, 2018, the U.S. Department of Justice (DOJ) issued a memorandum limiting the use of agency guidance documents in affirmative civil enforcement (ACE) cases. Stating that “[g]uidance documents cannot create...more
1/30/2018
/ Anti-Kickback Statute ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
Enforcement Actions ,
False Claims Act (FCA) ,
Local Coverage Determination (LCD) ,
MACs ,
Medicare ,
New Guidance ,
OIG
In a January 10, 2018 memo that leaked last week (the “Granston Memo”), the U.S. Department of Justice (“DOJ”) directs its prosecutors to more seriously consider dismissing meritless False Claims Act (“FCA”) cases brought by...more
Whistleblower Developments is a periodic report covering significant cases, decisions, proposals, and legislation related to whistleblower statutes and how they may impact your business. ...more
4/21/2017
/ Anti-Retaliation Provisions ,
Appeals ,
Denial of Certiorari ,
Dismissals ,
Dodd-Frank ,
False Claims Act (FCA) ,
Federal Contractors ,
Financial Industry Regulatory Authority (FINRA) ,
Hiring & Firing ,
Investment Adviser ,
Job Duties ,
Reporting Requirements ,
Retaliation ,
Reversal ,
Sarbanes-Oxley ,
Securities and Exchange Commission (SEC) ,
Sexual Orientation Discrimination ,
Split of Authority ,
Supervisors ,
Whistleblowers ,
Wrongful Termination
According to a memo circulating amongst Republican-party leaders as of February 13th, Republicans in the House of Representatives are planning to propose a significant curtailment of the U.S. Securities and Exchange...more
2/26/2017
/ Anti-Retaliation Provisions ,
Civil Monetary Penalty ,
Conspiracies ,
Consumer Financial Protection Bureau (CFPB) ,
Dodd-Frank ,
Enforcement Actions ,
False Claims Act (FCA) ,
Financial Services Industry ,
Foreign Corrupt Practices Act (FCPA) ,
Legislative Agendas ,
Morgan Stanley ,
OSHA ,
Popular ,
Retaliation ,
Rollbacks ,
Sarbanes-Oxley ,
Securities and Exchange Commission (SEC) ,
Separation Agreement ,
Waiver of Rights ,
Whistleblower Awards ,
Whistleblower Protection Policies ,
Whistleblowers
The Escobar and Sanford-Brown Decisions -
This summer, the United States Supreme Court undertook to resolve the long-running circuit split over the validity and scope of the implied false certification theory of...more
SEC Awards Another Whistleblowing Compliance Officer -
On April 22, 2015, the Securities and Exchange Commission (SEC) announced an award between $1.4 and $1.6 million to a compliance officer who provided information...more
7/8/2015
/ Attorney-Client Privilege ,
Certificates of Compliance ,
Chief Compliance Officers ,
Compliance ,
Confidentiality Agreements ,
Enforcement Actions ,
False Claims Act (FCA) ,
Financial Industry Regulatory Authority (FINRA) ,
Internal Investigations ,
IRS ,
Retaliation ,
Sarbanes-Oxley ,
Securities and Exchange Commission (SEC) ,
Tax Court ,
Upjohn Warnings ,
Whistleblower Awards ,
Whistleblower Protection Policies ,
Whistleblowers ,
Wrongful Termination
As most recently spotlighted by the Department of Justice’s intervention in whistleblower claims against ManorCare, DOJ is increasing its enforcement of the False Claims Act (FCA) against therapy providers. In particular, DOJ...more