False Claims Act

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The False Claims Act Takes Center Stage in the Trump Administration’s Anti-Fraud Strategy

By Squire Patton Boggs on Posted in Compliance, DOJ, False Claims Act
Federal enforcement of fraud involving taxpayer-funded programs, like Medicare, is intensifying and businesses that work with the US government should be paying close attention. The US Department of Justice’s latest guidance is designed to accelerate qui tam investigations, increase the role of whistleblowers and strengthen coordination across government agencies. Combined with a record-breaking $6.8 billion … Continue Reading

Federal Courts Continue to Grapple with Causation in Anti-Kickback-Based False Claims Act Cases

By Squire Patton Boggs on Posted in 1st Circuit, Anti-kickback Statute, DOJ, False Claims Act, Fraud and Abuse
Courts around the country continue to disagree on the causation standard to be applied in False Claims Act cases based on alleged Anti-Kickback Statute violations.  Two recent federal district court decisions out of the District of Massachusetts, United States v. Regeneron Pharms., Inc., No. 20-11217-FDS, 2023 WL 7016900 (D. Mass. Oct. 25, 2023) and United … Continue Reading

Supreme Court Clarifies Knowledge Requirement for False Claims Act Liability

By Squire Patton Boggs on Posted in Compliance, False Claims Act, U.S. Supreme Court
In April, we previewed two significant False Claims Act (FCA) cases before the U.S. Supreme Court, United States ex. rel. Schutte v. SuperValu, Inc., No. 21-1326 (“SuperValu”), and United States ex. Rel. Proctor v. Safeway, Inc., No. 22-111 (“Safeway”).  The FCA provides that “any person who knowingly presents, or causes to be presented, a false or fraudulent claim” to the United … Continue Reading

Healthcare Companies and Companies Doing Business with the US Government – Supreme Court Appears Likely to Clarify False Claims Act (FCA) Knowledge Requirements

By Squire Patton Boggs on Posted in Compliance, False Claims Act, U.S. Supreme Court
The Supreme Court recently heard oral argument in the appeal of two False Claims Act (FCA) cases from the Seventh Circuit that called into question the level of intent, or scienter, required to establish corporate liability under the FCA for “knowingly” overbilling the government for goods or services.  The Court’s eventual decision may have widespread … Continue Reading

Sixth Circuit Limits Anti-Kickback Claims Brought Under False Claims Act

By Squire Patton Boggs on Posted in 6th Circuit, Anti-kickback Statute, False Claims Act
Recently, the Sixth Circuit issued an important decision limiting the scope of claims alleging violations of the Anti-Kickback Statute that are brought under the False Claims Act. In Shannon Martin, M.D., et al. v. Hathaway, et al., No. 22-1463 (March 28, 2023), the court clarified the meaning of remuneration under the Anti-Kickback Statute. Squire Patton … Continue Reading

DOJ Prioritizes Health Care Fraud in the Pandemic

By Squire Patton Boggs on Posted in COVID-19, DOJ, False Claims Act, Fraud and Abuse
The Department of Justice (“DOJ”) recently announced its largest ever health care fraud and opioid enforcement action.  In a coordinated effort, DOJ charged 345 defendants with more than $6 billion in fraud losses for submitting false and fraudulent claims to federal health care programs and private insurers. The nationwide enforcement operation has been in motion since April … Continue Reading

CARES Act Medicare Money – View From Former Prosecutors

By Squire Patton Boggs on Posted in CARES Act, Civil Monetary Penalties Law, Compliance, COVID-19, Department of Health and Human Services, False Claims Act, Fraud and Abuse
The CARES Act requires Medicare providers to attest to multiple certifications.  Former prosecutors examine how law enforcement may scrutinize these certifications. Marisa Darden, David Maria, and Thomas Zeno also offer tips on how providers who receive CARES Act funds can insulate themselves from scrutiny.… Continue Reading

Third Circuit’s Rejection of the “Objective Falsehood” Requirement under the FCA is Challenged

By Max Czernin and Shing Tse on Posted in 3rd Circuit, False Claims Act
The appellee in United States ex rel. Druding v. Care Alternatives, Inc., 952 F.3d 89 (3d Cir. 2020) has sought rehearing of the Third Circuit’s holding that “objective falsehood” is not a requirement under the False Claims Act (“FCA”).  In reaching this holding, the Third Circuit considered whether a hospice-care provider’s claim for Medicare reimbursement … Continue Reading

Fraudulent Cardiologist Was Very Busy

By Squire Patton Boggs on Posted in 6th Circuit, False Claims Act, Fraud and Abuse
 Suspicious of the practices of one of its cardiologists, a hospital hired an independent expert to investigate. The expert examined records of 12 patients but “could not find support in any of the twelve cases” to implant pacemakers. The hospital terminated the doctor, and the government indicted him for health care fraud. During trial the government deployed an … Continue Reading

Is it Legal to Maximize Value of Secondary Diagnosis Codes?

By Squire Patton Boggs on Posted in CMS, False Claims Act, Fraud and Abuse, Hospitals, Medicaid
By selecting a more severe Secondary Diagnosis Code for a patient, a physician may increase the reimbursement due from Medicare. If a hospital intentionally changes codes across its patient population, the increased revenue can be substantial. Is that legal? A federal district court in Texas faced this question when a relator filed suit under the … Continue Reading

DOJ Challenges Charitable Copay Subsidies

By Squire Patton Boggs on Posted in Anti-kickback Statute, DOJ, False Claims Act, Fraud and Abuse, Pharmaceutical
The Department of Justice intervened in a False Claims Act lawsuit involving “so-called charitable patient assistance funds” used for prescription drug copays. The DOJ wants to make “clear that the Department will hold accountable drug companies that pay illegal kickbacks to facilitate increased drug prices.”  See a report at the Anticorruption blog here.… Continue Reading

New DOJ Guidance On Credit Under False Claims Act

By Squire Patton Boggs on Posted in DOJ, False Claims Act, Fraud and Abuse
The Department of Justice just released new guidance how to obtain credit for cooperation under the False Claims Act (FCA).  The guidance stresses the importance of cooperation but mentions other actions as well.  The FCA greatly impacts the health care sector, with settlements and judgments reaching to billions of dollars.  Please see the post on the Anticorruption blog … Continue Reading

Health Care Fraud Leads $2.8 Billion Collected for False Claims

By Squire Patton Boggs on Posted in Anti-kickback Statute, Department of Health and Human Services, DOJ, False Claims Act, Fraud and Abuse
The federal government’s civil recoveries for false claims during FY2018 topped $2.8 billion. Health care fraud claims lead the collection. Government Rakes in Billions The Department of Justice (DOJ) recently released statistics for its civil False Claims Act (“FCA”) recoveries during FY2018.   Although that total is lower than in some previous years, the trajectory of recoveries … Continue Reading

Doctors Personally Paying More False Claims Settlements

By Squire Patton Boggs on Posted in False Claims Act
Doctors are personally paying more settlements under the False Claims Act. In that regard, the Yates memorandum appears to be having its intended effect. The 2015 memo required investigators to focus more on individual liability when resolving fraud investigations. That year only 6 settlements forced doctors to pay when settling complaints filed under the False Claims … Continue Reading

Rosenstein’s Insights Into DOJ Enforcement

By on Posted in False Claims Act
U.S. Deputy Attorney General Rod Rosenstein promises an enforcement environment in which businesses can thrive. In a keynote address given at the U.S. Chamber Institute for Legal Reform, he emphasized the Department of Justice’s (DOJ) commitment to “avoiding unnecessary interference in law-abiding enterprises.” Rosenstein’s reassurance to the business community also included an apparent slight to … Continue Reading

Failing to Repay is Costly

By Squire Patton Boggs on Posted in False Claims Act
A recent civil settlement announced by the Department of Justice reminds providers that failing to repay the government can be as costly as fraudulent billing. Although a medical practice paid nearly $450,000 to resolve an investigation, the contested amount was only $175,000. That’s the kind of 250% penalty often associated with a false claim settlement. Similarly, this … Continue Reading
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