News & Analysis as of

Qui Tam False Claims Act (FCA)

Fifth Circuit Relies on Escobar in Vacating $663 Million FCA Judgment

by Bass, Berry & Sims PLC on

The U.S. Court of Appeals for the Fifth Circuit vacated a $663 million judgment, concluding that the Supreme Court’s opinion in Escobar doomed the plaintiff’s FCA claims on the issue of materiality....more

Early Victory: Judge Dismisses Qui Tam Suit Against UnitedHealthcare

by Arnall Golden Gregory LLP on

On October 5, 2017, in United States of America ex rel. Swoben v. Scan Health Plan, et al. (“Swoben”), Judge John F. Walter of the United States District Court for the Central District of California granted United Health...more

“No Fraud at All:” Fifth Circuit Reverses $663 Million False Claims Act Jury Verdict Based on Government’s Actual Knowledge

by Arnall Golden Gregory LLP on

On September 29, 2017, in United States ex rel. Harman v. Trinity Indus. Inc. (“Trinity”), the Fifth Circuit Court of Appeals reversed a $663 million jury verdict in a False Claims Act (FCA) case brought against Trinity...more

Under What Circumstances Can a Private Qui Tam Plaintiff Overrule Government Agency Experts' Use of Administrative Discretion to...

• How have appellate courts applied the Supreme Court’s ruling in Escobar? • If the government is aware of the relator’s allegation, but does not undertake any administrative action to address the defendant’s alleged...more

Mintz Levin Health Care Qui Tam Update - Recently Unsealed Whistleblower Cases: September 2017

by Mintz Levin on

In this month’s issue of our Qui Tam Update, we review an unusual cluster of five cases alleging that common defendants — a health care provider and its subsidiaries — provided medically unnecessary services to hospice,...more

Simpson v. Bayer Healthcare and the “Original Source” Exception: Eighth Circuit’s Interpretation Ups the Ante for Defendants in...

The Eighth Circuit in Simpson v. Bayer Healthcare became the latest circuit court to weigh in on the meaning of the “original source” exception to the False Claims Act’s public disclosure jurisdictional bar. The public...more

Significant FCA Decision Affirms the Importance of Materiality

by Reed Smith on

The U.S. Court of Appeals for the Fifth Circuit recently issued a well-reasoned decision that takes the rare step of overruling a jury finding of False Claims Act (FCA) liability, and erasing the damages award of more than...more

Newly Announced Chicago Health Care Fraud Unit Could Signal a Change in the Northern District of Illinois’s Health Care...

by Ropes & Gray LLP on

On July 18, 2017, Acting U.S. Attorney for the Northern District of Illinois, Joel R. Levin, announced the creation of a dedicated criminal Health Care Fraud Unit. The five prosecutor unit will operate within the Criminal...more

State + Local Tax Insights: Summer 2017

by Morrison & Foerster LLP on

Triple the Risk, Triple the Uncertainty: Tax False Claims Act Suits. - Part one of a two part series - During a single hearing in March 2016, a Cook County Circuit Judge dismissed over 200 False Claims Act (“FCA”) suits...more

Petratos v. Genentech: Escobar’s “Heightened Materiality Requirement” Is Significant Pleading Hurdle in False Claims Act Suits

In a recent False Act Claims (FCA) suit involving the blockbuster cancer drug Avastin, the Third Circuit barred a relator’s qui tam suit because his Complaint lacked sufficient factual allegations that, if true, would...more

Healthcare Law Update: September 2017

by Holland & Knight LLP on

OIG Advisory Opinions - Manufacturer's Free Replacement of Spoiled Pharmaceutical Products Authorized - On Aug. 25, 2017, the U.S. Department of Health and Human Services' (HHS) Office of Inspector General (OIG)...more

Eighth Circuit Rejects Sovereign Immunity Defense to FCA Qui Tam Action

by Dorsey & Whitney LLP on

Last month the Eighth Circuit considered and rejected an Eleventh Amendment sovereign immunity defense to a qui tam action under the False Claims Act. In United States ex rel. Fields v. Bi-State Development Agency, No....more

Second Circuit Accepts Appeal of False Claims Act First-To-File Issues

by Farrell Fritz, P.C. on

The Second Circuit recently agreed to accept an interlocutory appeal to decide the question whether a violation of the False Claims Act’s “first-to-file” rule compels dismissal of the complaint or whether it can be cured by...more

Implied False Certification Theory Fails in FCA Case Against Billing Agent

A court in the Southern District of New York (“SDNY” or the “Court”) recently released an important decision applying the Supreme Court’s landmark Escobar ruling to a qui tam action involving percentage fee arrangements for...more

The Four Things That Surprised Us in the EpiPen False Claims Settlement

On August 17, 2017, the U.S. Department of Justice (DOJ) announced that it had reached a $465 million false claims settlement with Mylan, the manufacturer of EpiPen, over the company’s alleged underpayment of Medicaid Drug...more

Sixth Circuit: Technical Physician Signature Deficiencies not "Material" to Reimbursement Claims

by Jones Day on

The District Court for the Middle District of Tennessee held on June 22, 2017, that the timing requirements related to a physician's certification of need for home health services were not "material" to the Centers for...more

Mintz Levin Health Care Qui Tam Update - Recently Unsealed Whistleblower Cases: August 2017

by Mintz Levin on

In this issue we report on recent qui tam activity and look at three unsealed cases. One case involves allegations of “up coding” by a hospital that allegedly billed routine transport as emergency transport, reimbursed at...more

Appellate Court Endorses FPPC’s “Reasonably Foreseeable” Test for PRA Conflicts Analysis

by Best Best & Krieger LLP on

A recent appellate decision illustrates the far-reaching and powerful impact of the Political Reform Act’s conflicts provisions, and how that law can be employed as a sword in litigation to negate or undo decisions of...more

Second Circuit Sets False Claims Act Pleading Standard For Claim Information

by Farrell Fritz, P.C. on

Last week, the Second Circuit held that a False Claims Act relator does not have to plead details of specific alleged false billings or invoices to the government, as long as he can allege facts leading to a strong inference...more

Contractors Need to Fully Address False Claims Act Allegations During Suspension or Debarment Proceedings

by Holland & Knight LLP on

Companies involved in False Claims Act suits filed by qui tam relators often find themselves facing potential suspension or debarment from federal contracting. A recent decision out of the United States District Court for the...more

Client Alert: Feds Shine a Light on Medicare Advantage Plans and Physicians Related to Risk Adjustment Practices

Although the sufficiency of medical records documentation supporting beneficiary diagnoses for Medicare Advantage (MA) risk adjustment has been on the OIG’s work plan since 2013, the Department of Justice has upped the ante...more

Ninth Circuit Relies on Escobar to Revive False Claims Act Suit Against Pharmaceutical Manufacturer

On July 7, 2017, the U.S. Court of Appeals for the Ninth Circuit reversed a federal district court’s dismissal of a False Claims Act (FCA) whistleblower suit in United States ex rel. Campie v. Gilead Sciences, explaining that...more

The False Claims Act: Why It Is Relevant To All Manufacturers

The False Claims Act (FCA) is a major civil enforcement tool used by the federal government to redress fraud causing monetary loss to the government. In the 2016 fiscal year, the federal government recovered over $4.7...more

FCA Deeper Dive: Judicial Review of Settlements

by Bass, Berry & Sims PLC on

The FCA continues to be the federal government’s primary civil enforcement tool for investigating allegations that healthcare providers or government contractors defrauded the federal government. In the coming weeks, we...more

Court Overreaches in Requiring Medical Necessity Determination by Labs

by Jones Day on

On June 9, 2017, the U.S. District Court for the District of Columbia denied a motion to dismiss brought by a laboratory in U.S. ex rel. Groat v. Boston Heart Diagnostics Corp., 2017 WL 2533341. Part of the grounds for...more

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