News & Analysis as of

Qui Tam Investigations

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

Akin Gump Strauss Hauer & Feld LLP

Courts Should Finally Rule That the False Claims Act Qui Tam Provisions Are Unconstitutional

Last term, in U.S. ex rel. Polansky v. Exec. Health Res., Inc., three Justices noted that there are “substantial arguments” that the False Claims Act’s (FCA) qui tam provisions do not conform with Article II of the...more

Perkins Coie

DOJ-Initiated False Claims Act Cases Reached Record High in Fiscal Year 2023

Perkins Coie on

The U.S. Department of Justice (DOJ) announced that it initiated a record-high 500 new False Claims Act (FCA) cases in Fiscal Year 2023. The government and whistleblowers (qui tam relators) were party to 543 settlements and...more

Mintz

EnforceMintz — COVID-19 Fraud Enforcement Unlikely to Slow Down in 2024

Mintz on

The government continued to dedicate enormous resources to investigating and prosecuting fraud against COVID-19 pandemic relief programs in 2023. While we observed some civil False Claims Act settlements, criminal enforcement...more

Bradley Arant Boult Cummings LLP

Overruled: Court Denies Relator’s Objection to False Claim Act Settlement

Significant work goes into settling a False Claims Act action. Defendants may spend months negotiating with the government to reach an agreeable settlement — often even longer if the defendant pursues the arduous...more

King & Spalding

U.S. Supreme Court Allows Justice Department to Dismiss Whistleblower Cases

King & Spalding on

On June 16, 2023, the U.S. Supreme Court affirmed that the DOJ properly secured a dismissal of a whistleblower suit accusing Executive Health Resources Inc. of violating the False Claims Act by improperly billing Medicare....more

ArentFox Schiff

US Supreme Court Rules 8-1 in Favor of Government FCA Dismissal Authority

ArentFox Schiff on

On June 16, 2023, in United States, ex rel. Polansky v. Executive Health Resources, Inc., the US Supreme Court addressed the government’s authority to dismiss a qui tam False Claims Act (FCA) suit over a relator’s objection...more

Jenner & Block

Client Alert: Future Implications of Low Dollar False Claims Act Recoveries for FY2022

Jenner & Block on

The Department of Justice (DOJ) has released its summary of False Claims Act (FCA) recoveries for Fiscal Year 2022. At $2.2 billion, financial recoveries were significantly lower than the $5.7 billion collected the year...more

Bradley Arant Boult Cummings LLP

Medicare Advantage Programs’ Increasing Popularity Invites Heightened FCA and Regulatory Scrutiny

As Medicare Advantage attracts more eligible beneficiaries, it is also drawing attention from False Claims Act (FCA) prosecutors. In 2022, enrollment in Medicare Advantage plans reached 28.7 million Medicare beneficiaries, or...more

Mintz - Health Care Viewpoints

The Government's Long Game for Investigating COVID-era Relief Fraud

n a recent article in the New York Times, David Fahrenthold outlined the big issue facing prosecutors investigating COVID-era fraud: the sheer magnitude of it. The title of the article, “Prosecutors Struggle to Catch Up to a...more

K&L Gates LLP

Qui Tam Quarterly - Data on Defense: Invalidating FCA Allegations Based on Statistical Sampling and Extrapolation

K&L Gates LLP on

Statistical sampling and extrapolation have become accepted tools for establishing damages in health care administrative proceedings and False Claims Act (FCA) litigation over the past 30 years. Key Takeaways - 1....more

Bass, Berry & Sims PLC

Anti-Retaliation under the False Claims Act

The False Claims Act encourages whistleblowers to come forward when they suspect their employer is committing fraud. This post provides a general overview of the False Claims Act’s anti-retaliation provision, which protects...more

Bass, Berry & Sims PLC

What Does the DOJ’s New Civil Cyber-Fraud Initiative Mean for You?

Bass, Berry & Sims PLC on

As discussed in a previous post, the Department of Justice (DOJ) has announced a new Civil Cyber-Fraud Initiative to utilize one of the strongest tools in its toolbox—the False Claims Act—to hold entities receiving federal...more

Health Care Compliance Association (HCCA)

[Event] Nashville Regional Healthcare Compliance Conference - November 5th, Nashville, TN

Our one-day Regional Compliance Conferences provide attendees with a forum to interact with local compliance professionals, share information about your compliance successes and challenges, and create educational...more

Bradley Arant Boult Cummings LLP

Proposed Bipartisan Legislation Would Further Burden the Defense of FCA Cases

The False Claims Amendments Act of 2021 (S. 2428), introduced late last month by a bipartisan group of senators led by Sen. Chuck Grassley (R-Iowa), could make defending False Claims Act (FCA) cases substantially more...more

ArentFox Schiff

Senator Chuck Grassley Introduces Bipartisan Amendments to False Claims Act Aimed at Clarifying “Confusion” Over Materiality...

ArentFox Schiff on

On Monday, Senator Chuck Grassley, R-Iowa, introduced the False Claims Amendments Act of 2021, section 2 of which would provide that defendants “may rebut an argument of materiality” as to an allegedly false claim submitted...more

Baker Donelson

Déjà Vu All Over Again: Pandemic Renews Focus on Ongoing False Claims Act Enforcement Priorities

Baker Donelson on

There are few areas that the pandemic has not touched, directly or indirectly. The Department of Justice Civil Division knows no different, as is reflected in its current statements regarding priorities for False Claims Act...more

K&L Gates LLP

The False Claims Act and Health Care: 2020 Recoveries and 2021 Outlook

K&L Gates LLP on

False Claims Act (FCA) civil fraud recoveries in Fiscal Year (FY) 2020 dropped over US$850 million when compared to those in FY 2019. While the more than US$2.2 billion in recoveries in FY 2020 continued a general downward...more

K&L Gates LLP

Qui Tam Quarterly - COVID-19 and the Big-Data Revolution of Health Care False Claims Act Litigation

K&L Gates LLP on

This edition of Qui Tam Quarterly focuses on: - the history of big data in health care FCA investigations and litigation; - how the government has increased its ability to gather health care claims data and use it to...more

K&L Gates LLP

Qui Tam Quarterly - Uncertain Relief: Navigating Cares Act Provider Relief Fund Guidance and False Claims Act Risks

K&L Gates LLP on

This edition of the Qui Tam Quarterly focuses on the potential False Claims Act (FCA) risk areas faced by health care provider recipients of payments from the Provider Relief Fund (PRF) created by the CARES Act, as well as...more

Mintz - Health Care Viewpoints

Massachusetts U.S. Attorney’s Office Enters into MOU with Office of the Special Inspector General for Pandemic Recovery

United States Attorney Andrew E. Lelling recently announced that the U.S. Attorney’s Office (USAO) for the District of Massachusetts entered into a Memorandum of Understanding (MOU) with Special Inspector General Brian D....more

ArentFox Schiff

Investigations Newsletter: Health Information Technology Developer to Pay $145 Million to Resolve Kickback Allegations

ArentFox Schiff on

In the DOJ’s first-ever criminal action against an electronic health records vendor, San Francisco-based Practice Fusion Inc. agreed to pay $145 million to resolve allegations that it received kickbacks from pharmaceutical...more

ArentFox Schiff

Deputy Associate Attorney General Sheds Light on DOJ’s FCA Priorities at Annual False Claims Act Conference

ArentFox Schiff on

“Enforcing the False Claims Act is a top priority for the Department—not just for our office,” said Deputy Associate Attorney General Stephen Cox, the Keynote Speaker for the 2020 Advanced Forum on False Claims and Qui Tam...more

King & Spalding

Healthcare Industry Faces Heightened Criminal Exposure Under New Criminal Division Review Process for Qui Tam Suits

King & Spalding on

The Assistant Attorney General for the Criminal Division, Leslie Caldwell, announced on September 17, 2014, that criminal prosecutors at the Justice Department in Washington will automatically review all new qui tam (i.e.,...more

Foley & Lardner LLP

Recent Decision Underscores Need for Involvement of Counsel in Internal Investigations

Foley & Lardner LLP on

A recent federal court decision raises concerns about the ability of companies to maintain privilege over materials generated in connection with internal investigations. The case, United States ex rel. Barko v. Halliburton...more

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