News & Analysis as of

Relators Healthcare Fraud

Morgan Lewis

Second Circuit Confirms ‘Willfulness’ Standard for Scienter Has Teeth Under the Anti-Kickback Statute and False Claims Act

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In a new decision that could have a significant impact on the persistent efforts of relators to reach otherwise lawful conduct and characterize it as a violation of the Anti-Kickback Statute (AKS), the US Court of Appeals for...more

Cozen O'Connor

Whistleblower Watch - A quarterly update on FCA Enforcement and Qui Tam Litigation - Winter 2024

Cozen O'Connor on

Whistleblower Watch is a comprehensive source for all False Claims Act (FCA) news and information. Every quarter, Cozen O’Connor will provide in-house counsel and compliance professionals with a summary of the most notable...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

Bass, Berry & Sims PLC

Second Circuit Rejects Insufficient Service-of-Process Argument, Adopts Relator-Friendly Rule

Bass, Berry & Sims PLC on

On November 28, the U.S. Court of Appeals for the Second Circuit held that the service-of-process clock for a False Claims Act (FCA) qui tam complaint begins to run when the district court orders the complaint to be served,...more

American Conference Institute (ACI)

[Event] 11th Annual Advanced Forum on False Claims and Qui Tam Enforcement - January 23rd - 24th, New York, NY

Hosted by American Conference Institute, the 11th Annual Advanced Forum on False Claims and Qui Tam Enforcement returns for another exciting year for lively discussions on FCA enforcement including the ramifications of two...more

Bass, Berry & Sims PLC

False Claims Act Decisions to Know from Q2 2023

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In this post, we summarize noteworthy False Claims Act (FCA) decisions from the second quarter of 2023. U.S. Supreme Court Decisions. The second quarter was particularly noteworthy because the Supreme Court decided two...more

Cozen O'Connor

Big Data, Big Recovery: The Emergence of Data Analytics in Healthcare FCA Enforcement

Cozen O'Connor on

Law enforcement, federal agencies, and private whistleblowers are increasingly working alongside data scientists to identify fraudulent practices by analyzing vast data sets. The application of data analytics has notably...more

Zuckerman Spaeder LLP

The Supreme Court Confirms the Government’s Essentially Unfettered Authority to Dismiss False Claims Act Cases

Zuckerman Spaeder LLP on

On Friday, June 16, 2023, I (sort of) lost my bet that the Supreme Court would follow the path charted in Borzilleri v. Bayer Healthcare Pharmaceuticals, 24 F.4th 32 (1st Cir. 2022) to determine the government’s False Claims...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

BakerHostetler

SCOTUS Majority Affirms the DOJ's Ability to Dismiss Whistleblower Cases Under the False Claims Act - But Dissent Raises Suspicion...

BakerHostetler on

On June 16, 2023, the United States Supreme Court issued an 8-1 decision in the case of United States, ex rel. Polansky v. Executive Health Resources, Inc., which held that the Department of Justice (DOJ) can move to dismiss...more

Cozen O'Connor

It’s (Not) About Time - Government May Move to Dismiss FCA Suit at Any Point During its Pendency

Cozen O'Connor on

On Friday, June 16, 2023, the United States Supreme Court (SCOTUS or the Court) upheld prior decisions by the trial court and Third Circuit in U.S. ex rel. Polansky v. Executive Health Resources, Inc. Polansky involves the...more

Wiley Rein LLP

Supreme Court Clarifies DOJ’s FCA Dismissal Authority

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WHAT: On June 16, 2023, the U.S. Supreme Court ruled 8–1 that the Government has broad authority to intervene and dismiss False Claims Act (FCA) suits litigated by relators. U.S. ex rel. Polansky v. Executive Health Resources...more

Stevens & Lee

Supreme Court Grants Government Broad Dismissal Rights in Qui Tam Cases

Stevens & Lee on

The U.S. Supreme Court, in an 8-1 decision written by Justice Kagan, held on June 16 that the United States (“Government”), having initially chosen not to intervene in a False Claims Act (“FCA”) qui tam case, but having...more

Epstein Becker & Green

The United States Is the FCA Party in Interest, Not the Relator – SCOTUS Today

Epstein Becker & Green on

It should come as no surprise to constitutionalists, practitioners under the Federal False Claims Act (31 U.S.C. §§3729–3733) (FCA), and auditors of the oral argument in the case that the Supreme Court has held that the...more

Bradley Arant Boult Cummings LLP

A Sight for Sore Eyes: Sixth Circuit Rejects Government’s Expansive AKS and FCA Theories in Ophthalmologist Dispute

This week, the Sixth Circuit closed two paths the government and relators have tried to take to expand liability for medical providers under the Anti-Kickback Statute (AKS) and False Claims Act (FCA): the meaning of...more

Hogan Lovells

Sixth Circuit weighs in on meaning of causation, remuneration for False Claims based on alleged kickbacks

Hogan Lovells on

The Sixth Circuit expanded the existing circuit split regarding when a kickback causes a federal health care claim to be false or fraudulent under the False Claims Act (FCA) and set out a new analysis for what constitutes...more

Hogan Lovells

The False Claims Act Guide: 2022 and the road ahead - Anti-kickback causation in FCA suits: text or purpose?

Hogan Lovells on

The emerging circuit split on the causation standard used to identify claims “resulting from” violations of the Anti-Kickback Statute (AKS) for purposes of the False Claims Act (FCA) raises proof problems for relators and the...more

Hogan Lovells

The False Claims Act Guide: 2022 and the road ahead - Executive summary

Hogan Lovells on

In 2022, False Claims Act (FCA) settlements and judgments totaled US$2.2 billion. Although this was one of the lowest annual recovery totals in years, there is no indication that the Department of Justice (DOJ) is slowing its...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

Akerman LLP - Health Law Rx

Mind Games: SCOTUS to Rule on what “Knowing” Means under the False Claims Act

What does it mean to “knowingly” or “recklessly” violate the law when that law consists of highly complex and ever-changing regulations, which may be open to interpretation? The U.S. Supreme Court recently agreed to review...more

Quarles & Brady LLP

Supreme Court to Review the Objective Scienter Standard Under the False Claims Act in U&C Drug Pricing Suits

Quarles & Brady LLP on

On January 13, 2023, the United States Supreme Court granted certiorari1 to review the False Claims Act (“FCA”) scienter standard in two FCA whistleblower cases from the Seventh Circuit, U.S. ex rel. Schutte v. SuperValu...more

Benesch

Top 10 Lessons Learned from the Government’s Complaint Against Modern Vascular

Benesch on

Last month, the United States formally joined in the qui tam relator case against Arizona-based Modern Vascular. The action, originally filed in 2020 by relators Dr. Jay Radhakrish and Dr. William Julien, and since joined by...more

Hogan Lovells

New circuit split on evidence needed to prove a kickback renders a claim false or fraudulent

Hogan Lovells on

The Eighth Circuit released an opinion Tuesday in U.S. ex rel. Cairns v. D.S. Medical LLC that creates a new circuit split on the interpretation of the causation standard for establishing that a claim “resulting from” a...more

Kramer Levin Naftalis & Frankel LLP

Updates From ACI’s Advanced Forum on False Claims and Qui Tam Enforcement, June 22-23 in New York

Government, industry and outside counsel convened in New York June 22-23 at ACI’s Advanced Forum on False Claims and Qui Tam Enforcement to discuss recent trends in False Claims Act (FCA) case law and enforcement priorities....more

Polsinelli

SCOTUS to Determine Key Aspects of Government Dismissal Authority in FCA Cases

Polsinelli on

The United States Supreme Court recently agreed to hear a case interpreting the False Claims Act (“FCA”) that may affect the government’s involvement in pending and future matters. To resolve a circuit split, the Court will...more

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