News & Analysis as of

Department of Justice (DOJ) Medicare Qui Tam

Hendershot Cowart P.C.

Whistleblower Lawsuit Results In $15 Million Settlement Over Medicare, False Claims Act Violations

Hendershot Cowart P.C. on

On Monday, the Department of Justice (DOJ) announced a record $15 million settlement to resolve claims that Baylor St. Lukes Medical Center, Baylor College of Medicine, and Surgical Associates of Texas were billing Medicare...more

ArentFox Schiff

Investigations Newsletter: Florida Lab Owner Agrees to Pay Over $27 Million to Resolve Three Whistleblower Lawsuits

ArentFox Schiff on

Florida Lab Owner Agrees to Pay Over $27 Million to Resolve Three Whistleblower Lawsuits - Daniel Hurt, the prior owner and operator of Fountain Health Services LLC, Verify Health, Landmark Diagnostics LLC, First Choice...more

Morrison & Foerster LLP

DOJ Releases 2024 COVID-19 Fraud Enforcement Task Force Report

On April 9, 2024, the United States Department of Justice (DOJ) released a report on the COVID-19 Fraud Enforcement Task Force (“Task Force”), by far DOJ’s most comprehensive review of the Task Force since its creation in...more

Mintz - Health Care Viewpoints

DOJ Releases COVID-19 Fraud Enforcement Task Force Report Touting Its Successes and Urging Lawmakers to Enact New Legislation

The government’s continued dedication of resources to investigating and prosecuting fraud against COVID-19 pandemic relief programs appears to have borne fruit according to the results of the COVID-19 Fraud Enforcement Task...more

Pietragallo Gordon Alfano Bosick & Raspanti,...

FY 2023 False Claims Act Recoveries: $2.67 Billion In Recoveries And Over $349 Million In Awards To Whistleblowers

On February 22, 2024, the Department of Justice (“DOJ”) published its annual review of cases and recoveries under the False Claims Act. Through the end of fiscal year 2023, total recoveries (across all years) under the False...more

ArentFox Schiff

Investigations Newsletter: Ultragenyx to Pay $6 Million To Settle False Claims Act Case

ArentFox Schiff on

Ultragenyx to Pay $6 Million To Settle False Claims Act Case - Ultragenyx Pharmaceutical Inc. recently agreed to pay $6 million to settle a qui tam action filed under the False Claims Act (FCA). Ultragenyx manufactures a...more

Paul Hastings LLP

SuperValu and Executive Health Resources: What to Know About the FCA Following the 2023 Term

Paul Hastings LLP on

As we take stock of the Supreme Court’s 2023 term, two landmark decisions shift our understanding of scienter and government intervention as it relates to the False Claims Act (“FCA”), 31 U.S.C. § 3729. First, on June 1,...more

Husch Blackwell LLP

DOJ Continues Enforcement Efforts Against Provider-Owned Managed Care Plans

Husch Blackwell LLP on

Large managed care plans have been squarely in DOJ’s crosshairs for years, but a late July 2023 Justice Department settlement agreement with one regional healthcare provider’s Medicare Advantage Plan offers a glimpse into an...more

Morrison & Foerster LLP

True Facts About False Claims: MoFo's FCA Newsletter - July 2023

Designed for busy in-house counsel and compliance professionals, this newsletter seeks to bring you up to speed on key federal and state False Claims Act (FCA) developments, with links to primary resources. Each quarter, we...more

Troutman Pepper

Does the Government Retain Control of False Claims Act Cases?

Troutman Pepper on

United States ex rel. Polansky v. Executive Health Resources, Inc. (S. Ct. June 16, 2023) - The vast majority of False Claims Act cases are initiated by private parties, known as relators, not the government. In fact,...more

Rivkin Radler LLP

Surgeon Settles Simultaneous Surgery Suit

Rivkin Radler LLP on

The U.S. Department of Justice announced on February 27 that the University of Pittsburgh Medical Center (UPMC), James Luketich, its Chair of Cardiothoracic Surgery, and University of Pittsburgh Physicians have agreed to pay...more

Bradley Arant Boult Cummings LLP

Key Insights from DOJ’s False Claims Act Statistics for Fiscal Year 2022

The Department of Justice (DOJ) released its annual summary of False Claims Act (FCA) recoveries for the prior fiscal year, and the data points to a number of notable trends. Although DOJ brought in the second-highest...more

Bass, Berry & Sims PLC

False Claims Act Fundamentals: Self-Disclosures

Bass, Berry & Sims PLC on

When healthcare providers and other government contractors are subject to scrutiny for bills submitted to the government, it is often the result of a whistleblower complaint filed under the qui tam provisions of the False...more

Benesch

Modern Vascular is the Latest Defendant in a Growing Trend of Qui Tam Relator Cases against Office-based Lab Companies

Benesch on

Earlier this month a federal judge unsealed a federal qui tam relator complaint originally filed in January 2020 by Dr. Jay Radhakrishnan and Dr. William Julien against Arizona-based Modern Vascular and certain of its...more

Pillsbury Winthrop Shaw Pittman LLP

U.S. Supreme Court to Resolve a Circuit Split Involving Qui Tam Actions

The Court will decide whether the government can dismiss qui tam actions after initially declining to intervene and what standard courts should apply to the government’s dismissal request. The Supreme Court agreed to...more

Wiley Rein LLP

Supreme Court to Consider DOJ’s Dismissal Authority in False Claims Act Qui Tam Cases

Wiley Rein LLP on

What: The U.S. Supreme Court recently granted certiorari on a petition seeking to curtail the U.S. Department of Justice’s (DOJ) ability to dismiss False Claims Act (FCA) qui tam cases, even if DOJ has determined that the...more

Dorsey & Whitney LLP

DOJ Announces Settlement with Home-Health Services Company Over FCA Kickback and Overbilling Allegations

Dorsey & Whitney LLP on

The Department of Justice recently announced that it resolved two civil lawsuits filed under the qui tam, or whistleblower, provisions of the False Claims Act to the tune of nearly $4 million. The suits alleged that a...more

McDermott Will & Emery

Recent Litigation Shines Spotlight on Hospital and Physician Group Transactions

McDermott Will & Emery on

The US Department of Justice recently intervened in an qui tam alleging false and fraudulent claims involving the acquisition of physician practice locations by a health system and subsequent management of the health system’s...more

ArentFox Schiff

Investigations Newsletter: DOJ Attorneys Comment on the Rise of Telehealth Fraud During the COVID-19 Pandemic

ArentFox Schiff on

DOJ Attorneys Comment on the Rise of Telehealth Fraud During the COVID-19 Pandemic - During the 2022 Qui Tam Conference of the Federal Bar Association, DOJ attorneys commented on the dramatic rise in the use of remote...more

Mintz - Health Care Viewpoints

Health Care Enforcement Year In Review & 2022 Outlook

STATISTICAL TRENDS IN FALSE CLAIMS ACT LITIGATION - FCA case activity for 2021 reveals seemingly contrary trends. For the federal fiscal year (FY) that ended September 30, 2021, the DOJ annual report on FCA enforcement...more

Wiley Rein LLP

2021 FCA Recoveries Bounce Back from Decade-Low . . . Maybe

Wiley Rein LLP on

On February 1, the U.S. Department of Justice (DOJ) announced the second-largest annual total recoveries in the history of the False Claims Act (FCA)—$5.6 billion—for FY 2021 (October 2020 – September 2021)...more

Smith Gambrell Russell

Good News and Bad News Regarding Excessive Fines Clause in DOJ-declined FCA Cases

The Eleventh Circuit recently ruled that the Excessive Fines Clause applies in declined qui tam cases. That is the good news. However, the Eleventh Circuit also upheld a judgment where the ratio of total liability to actual...more

ArentFox Schiff

Investigations Newsletter: DOJ Files Complaint in AWP False Claims Act Suit Against Pharmaceutical Ingredient Seller 

ArentFox Schiff on

DOJ Files Complaint in AWP False Claims Act Suit Against Pharmaceutical Ingredient Seller - On November 8, 2021, the Department of Justice (DOJ) announced that it intervened in a qui tam suit and filed a False Claims Act...more

Dorsey & Whitney LLP

Enforcement Standards Tighten on Private Insurers: Sutter Health Settles for $90 Million Following Dispute With DOJ

Dorsey & Whitney LLP on

On August 30, 2021, the Department of Justice (“DOJ”) announced that Sutter Health and several of its affiliated entities (“Sutter”) agreed to pay a total of $90 million to settle allegations that Sutter violated the False...more

Bricker Graydon LLP

Skilled nursing facility operator settles false claims case involving allegations that the company failed to report and return...

Bricker Graydon LLP on

On June 29, 2021, the Department of Justice (DOJ) announced a settlement with California skilled nursing facility operator Plum Healthcare Group LLC and facility Azalea Holdings LLC dba McKinley Park Care Center (Plum) to...more

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