News & Analysis as of

Summary Judgment False Claims Act (FCA) Medicare

Stevens & Lee

First Circuit Rules Against Government in False Claims Act Case

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On Feb. 18, in U.S. v. Regeneron Pharmaceuticals, the First Circuit Court of Appeals joined the Sixth Circuit and the Eighth Circuit in holding that, for purposes of establishing that a claim for payment of items or services...more

Foley Hoag LLP - White Collar Law &...

District Court Grants Summary Judgment Win to False Claims Act Defendants, Adopting But-For Causation Standard for Claims Based on...

Courts continue to reject aggressive Anti-Kickback Statute (“AKS”) allegations. Most recently, on January 6, 2025, Judge Patti Saris of the U.S. District Court for the District of Massachusetts dismissed a qui tam action...more

ArentFox Schiff

Investigations Newsletter: Federal Judge Rules Government Must Demonstrate “But-For” Causation for Anti-Kickback Statute Claims

ArentFox Schiff on

Federal Judge Rules Government Must Demonstrate “But-For” Causation for Anti-Kickback Statute Claims - On September 27, 2023, Chief Judge Dennis Saylor of the US District Court for the District of Massachusetts ruled that...more

Mintz - Health Care Viewpoints

Courts Continue to Grapple with the Causation Standard for False Claims Act Suits Based on Alleged Kickback Schemes, While the...

A recent Massachusetts Federal District Court decision adds to divergent opinions deciding an important health care enforcement question: what causation standard applies to a False Claims Act (FCA) case based on a violation...more

Bradley Arant Boult Cummings LLP

Third Circuit Finds Documentation Issues May Be “Material” under the FCA

On August 25, 2023, the Third Circuit continued its trend of rulings unfavorable to FCA healthcare defendants in the latest appeal of U.S. ex rel. Druding et al. v. Care Alternatives et al., No. 22-1035, 2023 WL 5494333 (3d...more

Bass, Berry & Sims PLC

Supreme Court Declines to Weigh in on Key Falsity Question

Bass, Berry & Sims PLC on

For several years, courts have wrestled with the question of whether subjective clinical decisions regarding the type and amount of treatment patients may need can be false for purposes of establishing False Claims Act (FCA)...more

Foley & Lardner LLP

AseraCare FCA Ruling Is A Boon For Health Providers

Foley & Lardner LLP on

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

Hogan Lovells

FCA Alert: Decision Opens Door to Challenge of Agency Guidance in False Claims Cases

Hogan Lovells on

On November 5, 2019, the United States District Court for the Eastern District of Pennsylvania ruled on a motion to dismiss a False Claims Act (FCA) qui tam suit filed by the United States Department of Justice, long after it...more

Foley Hoag LLP - White Collar Law &...

Eleventh Circuit Holds Differences in Clinical Judgment Do Not Create FCA Liability for Hospice Provider

The Eleventh Circuit agreed with the trial court that the government must do more than present expert evidence that a physician’s clinical judgment was inaccurate to establish falsity under the False Claims Act. Nonetheless,...more

Holland & Knight LLP

Healthcare Law Update: September 2018

Holland & Knight LLP on

Regulation - CMS Contemplating Telemedicine Changes - The Centers for Medicare & Medicaid Services (CMS) recently published what it described as a "major proposed rule" that covers a number of topics that could have...more

Sheppard Mullin Richter & Hampton LLP

Temporal Proximity Is Not Enough: Third Circuit Nixes FCA/Anti-Kickback Suit For Failure To Link Alleged Scheme to Claims

On January 19, 2018, the United States Court of Appeals for the Third Circuit affirmed a district court’s ruling granting summary judgment to a specialty pharmacy that was accused of violating the Anti-Kickback Statute and...more

Jones Day

Third Circuit Rejects False Claims Act Theory that Anti-Kickback Violations "Taint" All Related Claims

Jones Day on

The Situation: A provision in the False Claims Act ("FCA") had clarified when Anti-Kickback Statute ("AKS") violations can make a claim false, but the provision's rule of per se falsity does not answer when a claim "result[s]...more

Baker Donelson

Court Puts the Brakes on Whistleblower's FCA Parking Claims

Baker Donelson on

The Department of Justice (DOJ) reports that, in fiscal year 2016 ending September 30, it obtained more than $4.7 billion in settlements and judgments from civil cases involving fraud and false claims. More than half of this...more

Faegre Drinker Biddle & Reath LLP

Who Says Ignorance of the Law Is No Excuse?

If you think that ignorance of the law is no excuse, take a look at the Eleventh Circuit’s opinion in US ex rel. Phalp v. Lincare Holdings. It leaves no doubt that in a False Claims Act case, ignorance can be a solid defense....more

Holland & Knight LLP

Healthcare Law Update: December 2016

Holland & Knight LLP on

Prompt Payment Discounts Not an Anti-Kickback Statute Violation - In United States of Am. et al. ex rel. Ruscher v. Omnicare, No. 15-20629, 2016 WL 6407128 (5th Cir. Oct. 28, 2016), the court of appeals affirmed summary...more

Faegre Drinker Biddle & Reath LLP

The Law Doesn’t Forbid Submitting False Claims

An Eighth Circuit decision provides a reminder that the False Claims Act doesn’t forbid submitting false claims: it forbids knowingly submitting false claims. That made all the difference in an appeal of summary judgment in...more

Parker Poe Adams & Bernstein LLP

Court Dismisses Major False Claims Act Case Against Hospice Provider: Ruling Mere Difference of Medical Opinion is Insufficient...

On March 31, 2016, the United States District Court for the Northern District of Alabama in U.S. ex rel. Paradies v. AseraCare, Inc. dismissed a major False Claims Act case against a national hospice provider after ruling...more

Bryan Cave Leighton Paisner

AseraCare Defeats DOJ False Claims Act Suit: Plaintiffs Must Present Evidence of an Objective Falsehood to Prove Falsity Under the...

On March 31, 2016, in United States v. AseraCare, Inc, No. 2:12-cv-245-KOB, 2016 U.S. Dist. LEXIS 42986 (N.D. Ala. Mar. 31, 2016), the district court granted summary judgment for AseraCare and emphasized that contradicting...more

Faegre Drinker Biddle & Reath LLP

No False Claim Despite Violation of Licensing Law and Medicare Conditions of Participation

Last week a federal court in Florida granted a radiology practice’s motion for judgment in its favor in a False Claims Act case, despite these formidable obstacles: (1) the practice had billed Medicare for services performed...more

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