News & Analysis as of

Whistleblowers False Claims Act (FCA) Healthcare Fraud

Recent Healthcare Fraud Suit Puts Private Equity Industry on Notice as to Potential Liability for Portfolio Company Conduct

by White and Williams LLP on

In February, the Department of Justice (DOJ) intervened in a False Claims Act case alleging healthcare fraud, a common enough event. The case in question, originally began in 2015 as a whistleblower case brought by two...more

Seeking Dismissal Of False Claims Qui Tam Actions – Seven Factors Clarify The Standard Of Dismissal Used By The Department Of...

The U.S. Department of Justice Civil Division (Department) issued a Memo dated January 10, 2018 (Granston Memo), directing Department of Justice attorneys to more seriously consider dismissing False Claims Act (FCA) cases...more

Designing Clinical Studies To Avoid Regulatory Scrutiny

Practical advice following the Primex Clinical Laboratories settlement - Earlier this year, the Department of Justice (DOJ) announced a $3.5 million settlement against Primex Clinical Laboratories, a California laboratory...more

Another Banner Year for False Claims Act Recoveries Signals More of the Same for 2018

by Blank Rome LLP on

The Department of Justice (“DOJ”) reported $3.7 billion in False Claims Act (“FCA”) settlements and judgments for fiscal year 2017, the 8th straight year of 3-plus-billion-dollar recoveries and 700-plus new cases filed....more

The Case of the Bashful Whistleblower

by Faegre Baker Daniels on

William Nash filed a whistleblower case against his former employer but wanted to remain anonymous so that his new employer wouldn’t know that he is—you guessed it–a whistleblower. William’s qui tam action alleged Medicaid...more

Medicaid Fraud Whistleblower Loses Bid To Keep His Name Out Of The Public Eye

by Farrell Fritz, P.C. on

False Claims Act whistleblowers expose themselves to significant risks by coming forward and asserting claims of fraud against the government. Often, the whistleblowers, called relators under the False Claims Act, would...more

Federal Court Strikes DOJ's Risk Adjustment False Claims Act Case - For Now

by Pepper Hamilton LLP on

On October 5, a federal district court in California dealt a significant setback to the government’s efforts to extend False Claims Act (FCA) liability to Medicare risk adjustment submissions....more

False Claims Act Watch: California Federal Judge Dismisses DOJ Complaint Alleging Medicare Advantage Fraud

by Kelley Drye & Warren LLP on

On October 5, the U.S. Department of Justice suffered a setback when a California federal judge dismissed its complaint under the civil False Claims Act (“FCA”). Billed as a test case for the Government, it marked the first...more

Alert: In a Surprise Decision Issued on October 5, 2017, Honorable John Walter, United States District Judge, Dismissed a Medicare...

On October 5, 2017, the Honorable Judge John Walter of the United States District Court, Central District of California, granted the Defendants’ Motion to Dismiss the Medicare Advantage (“MA”) Federal False Claims Act (“FCA”)...more

Ninth Circuit Denies Arbitration in a False Claims Act Case

On September 11, 2017, the Ninth Circuit in US and State of Nevada ex rel. Welch v. My Left Foot Children’s Therapy, LLC, upheld the denial of the defendant’s motion to compel arbitration in a False Claims Act (FCA) relator...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

Bad News for Whistleblowers: Defendant Pleads Guilty

by Faegre Baker Daniels on

At first glance, it looks nonsensical. How could it be bad news for False Claims Act whistleblowers that the defendant pleaded guilty to violating that statute—to committing the very Medicare fraud the whistleblowers alleged?...more

Genesis Healthcare Settlement with Federal Government

by Dorsey & Whitney LLP on

On June 16th, 2017, The Department of Justice (“DOJ”) announced a $53.6 million dollar settlement with Genesis Healthcare Inc. (“Genesis”) over six federal whistleblower lawsuits alleging that subsidiaries of the...more

Court Puts the Brakes on Whistleblower's FCA Parking Claims

by Baker Ober Health Law 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

Why Healthcare and Life Sciences Companies Need to Step Up Their Compliance Efforts in Advance of a U.S. Government Investigation

by Hogan Lovells on

In this interview, Hogan Lovells partner Gejaa Gobena discusses how the perception of compliance, remediation, and self-disclosure has evolved in the eyes of government prosecutors from how they factor at...more

The Siege Continues: The Justice Department is Investigating Four Additional Medicare Advantage Plans

In our prior blog post, we reported that, at the request of the federal Department of Justice, the FCA qui tam whistleblower lawsuit in the case of United States ex rel Benjamin Poehling v. United HealthGroup, Inc., et. al....more

DOJ Intervenes in Risk Adjustment FCA Case

by Bass, Berry & Sims PLC on

Recently, the DOJ intervened in one of several currently pending qui tam cases involving Medicare Advantage (MA) and the Risk Adjustment process used to determine the amount of payments to Medicare Advantage Organizations...more

Far-Fetched Whistleblower Claim of the Month

by Faegre Baker Daniels on

The hospital industry is accustomed to far-fetched whistleblower claims: allegations that a hospital knowingly submitted false or fraudulent Medicare or Medicaid claims or fired a whistleblower for trying to prevent such...more

False Claims Act: 2016 Year in Review

We are pleased to present Bradley’s annual review of significant False Claims Act (FCA) cases, developments, and trends. From a relatively short article several years ago, the Review has grown to a significant publication...more

Healthcare Law Update: December 2016

by 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

DOJ Recovers Over $4.7 Billion in False Claims Act Suits in Fiscal Year 2016

by King & Spalding on

On December 14, 2016, the Department of Justice (DOJ) announced that it recovered more than $4.7 billion in settlements and judgments involving fraud and false claims in fiscal year 2016. The fiscal year 2016 recovery...more

False Claims Act Basics – Known Overpayment Becomes False Claim

by Ruder Ware on

The Federal False Claims Act (“FCA”) provides a very strong enforcement tool to the federal government. The FCA also provides the opportunity for whistleblowers to bring “qui tam” cases and collect a portion of the recovery...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

Healthcare Compliance: Juggling Risk Mitigation Strategies

by Michael Volkov on

Healthcare organizations – ranging from physician practice groups to large, multi-state hospital systems – face a variety of risks, including fraud and abuse, as well as HIPAA privacy issues. Starting from a baseline risk...more

Check Up on Healthcare Fraud Prosecutions

by Michael Volkov on

Chief compliance officers face an overwhelming level of risk in the healthcare sector. I do not mean to belittle the risks of corruption, AML, sanctions and other risks typically associated with global companies. Healthcare...more

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