News & Analysis as of

Whistleblowers False Claims Act (FCA) Fraud

E.D. Virginia Allows FCA Whistleblower Retaliation Claim To Proceed

Background. Plaintiff worked with the Senior Advisor for Veteran Employment for the Department of Veteran Affairs (“Senior Advisor”) to develop an online veterans’ employment assistance program. The Senior Advisor’s husband...more

Three Recent Fraud Cases Involving Dermatologists Illustrate Primary Compliance Risks in Dermatology Practices

by Ruder Ware on

Three relatively recent cases involving dermatology billing practices illustrate some of the main compliance risks faced by dermatology practices...more

Corporate Investigations and White Collar Defense - March 2017

DOJ's New Guidance for Evaluating Corporate Compliance Programs - Why it matters: On February 8, 2017, the DOJ released, to little fanfare, a new guidance document entitled "Evaluation of Corporate Compliance Programs."...more

Corporate Investigations and White Collar Defense - February 2017

When Regulatory Failings Turn Criminal: Car Edition Redux - Why it matters: To paraphrase the famous quote from the film “All About Eve”: Fasten your seatbelts, it’s going to be a bumpy car ride. In the first part of...more

Whistleblowers on Campus: DOJ Adds Research Universities to its False Claims Act Focus

by Carlton Fields on

Federal funding is the grand prize for higher education research institutions. Each year, the federal government pumps hundreds of millions of dollars in research grants and awards into the university system. These funds are...more

Tenet Healthcare Settles Fraud Case for $514 Million

by Michael Volkov on

If you work in compliance in the healthcare industry, you have a tough job. The number and variety of risks that healthcare providers face is daunting. The False Claims Act is a mighty weapon in the hands of federal...more

Seventh Circuit Issues Ruling Interpreting False Claim Act Whistleblower Amendments

The Seventh Circuit recently issued a decision interpreting the anti-retaliation provisions of the False Claims Act (FCA). The decision provides important clarifications about how courts may interpret recent amendments to...more

False Claims Act Developments Significantly Impact a Broad Range of Industries Doing Business with the U.S. Government

No other area of government enforcement or civil liability has experienced anything quite like the three dramatic developments in initiation, penalties and standards for False Claims Act cases over the last twelve months. FY...more

7th Cir. Demands Objective Standards in Whistleblower Complaint

by Faegre Baker Daniels on

On September 1 the Seventh Circuit affirmed dismissal of three of a whistleblower’s four fraud allegations against a mental health clinic, ruling that the allegations were based on the whistleblower’s subjective judgment...more

Seventh Circuit Clarifies “Heightened” Pleading Standard for Fraud Claims under the False Claims Act

A recent decision of the United States Court of Appeals for the Seventh Circuit addressed the standard that courts should use to decide whether a whistleblower plaintiff has adequately pleaded that a defendant committed fraud...more

Your daily dose of financial news - The Brief – 7.28.16

by Robins Kaplan LLP on

A pair of whistleblowers is seeking discovery-related sanctions against Wells Fargo for allegedly concealing “crucial evidence” for their False Claims Act claims over fees added to government-backed mortgages....more

First District Tells Relators: Know Your Role in State Whistleblower Actions

by Carlton Fields on

Last week, the Florida First District Court of Appeal issued a decision of first impression confirming the controlling role that the Attorney General’s office plays in the life, or death, of a whistleblower action in Florida....more

Mitigating FCA Whistleblower Risk When Employees Leave

by McGuireWoods LLP on

Over the past decade, efforts to enforce health care fraud regulations have been bolstered significantly with increased government funding and a dramatic increase in whistleblower claims filed under the False Claims Act’s qui...more

Whistleblower Filed Too Early & Too Late for Share of $322M SCAN Scam Recovery

by Faegre Baker Daniels on

During his days as a data encounter manager at SCAN, Jim suspected the company had been double-billing Medicare and Medicaid for years. He expressed his concerns within SCAN. When he refused a job reassignment, he was fired....more

Ninth Circuit Eases Ability for Whistleblowers to Bring Qui Tam Actions

by PilieroMazza PLLC on

In an important development under False Claims Act (“FCA”) case law, the U.S. Court of Appeals for the Ninth Circuit has expressly abrogated former precedent limiting the ability of whistleblowers to recover funds reimbursed...more

Wisconsin Repeals State False Claims Act

by Polsinelli on

On July 12, 2015, the state of Wisconsin passed a budget that, along with many expected cuts, additions, and tweaks, unexpectedly repealed Wisconsin’s False Claims for Medical Assistance Act—the state’s version of the federal...more

Felony Conviction Bars Whistleblower from Pursuing Qui Tam Case

by Morgan Lewis on

A relator convicted of criminal conduct is precluded from sharing in related FCA recoveries, irrespective of degree of culpability. On July 16, a US Court of Appeals for the Ninth Circuit panel upheld the dismissal from...more

Ninth Circuit Concludes that Conviction Precludes Relator Recovery

by Dorsey & Whitney LLP on

The Ninth Circuit last week held that pursuant to 31 U.S.C. 3730(d)(3) of the False Claims Act (“FCA”), a qui tam relator who is convicted of conduct giving rise to the fraud that is the subject of the FCA lawsuit must be...more

The Fourth Circuit Expands the Implied Certification Theory to Anti-Retaliation Claims

by McGuireWoods LLP on

On January 8, 2015, the Fourth Circuit determined that, amid a circuit split, the “implied certification” theory of liability under the False Claims Act (“FCA”) was viable in the Fourth Circuit. United States v. Triple...more

Dialysis Provider Settles Whistleblower Lawsuit for $450 Million

by Dorsey & Whitney LLP on

The Department of Justice and dialysis provider DaVita Healthcare Partners recently finalized a $450 million agreement settling claims that the company intentionally inflated Medicare billings. The parties had filed a joint...more

D.C. Circuit Interprets the First-to-File Rule Narrowly

by Dorsey & Whitney LLP on

A decision this week from the D.C. Circuit shed light on three important issues. United States ex rel. Heath v. AT&T, Inc., No. 14-7094 (D.C. Cir. June 23, 2015). In 2008, the appellant, Todd Heath, filed an FCA qui tam...more

SCOTUS: No Unlimited Suspension of the Statute of Limitations Under the False Claims Act; “First-to-File” Doctrine Does Not Bar...

In an opinion released May 26, 2015, Kellogg Brown & Roots Services, Inc. v. United States ex rel. Carter, the U.S. Supreme Court unanimously held that whistleblowers cannot extend the statute of limitations for war-related...more

The Guards Who Couldn’t Shoot Straight: Fourth Circuit Endorses “Implied Certification” Theory Under False Claims Act

by Williams Mullen on

Does the federal False Claims Act (“FCA”) require the submission of an “objectively false statement” to the government? When does a company’s knowing failure to comply with contractual terms amount not just to a breach of...more

Changing Regulatory Regime Necessitates New Solutions To An Old Problem: 5 Elements Critical To An Anti-Fraud Compliance Program

by DLA Piper on

US government regulators have become more aggressive in their detection and enforcement of fraud against the government. One of the key tools they are using to combat such fraud is the False Claims Act. Most FCA cases are...more

Seventh Circuit: No Fraud in Billing Medicaid More than Private Insurers for Drugs

by Faegre Baker Daniels on

Last Wednesday the Seventh Circuit affirmed the dismissal of a whistleblower suit brought by a pharmacist against his former employer, the Shopko pharmacy chain, for what he alleged was fraudulent billing of Medicaid by...more

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