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
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
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
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
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
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
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
With their insider access to business operations, whistleblowers will follow stimulus money to learn whether the business abides by the strings attached to that money. Whistleblowers look for an opportunity to cash in on what they consider fraudulent conduct. What’s a business to do? See our discussion here on the Anticorruption blog. … Continue Reading
The Civil Division’s priorities for pursuing recoveries under the False Claims Act during 2020 were discussed by Assistant Attorney General Joseph “Jody” Hunt. See a summary and analysis here by David Maria and Trevor Garmey in the Anticorruption blog. … Continue Reading
The government incentivizes whistleblowers in order to increase healthcare recoveries under the False Claims Act. See our analysis here of how the Act’s qui tam provisions work by Colin Jennings, Marisa Darden, and Ayako Hobbs. … Continue Reading
Once again, healthcare leads other industries for recoveries by the government and whistleblowers under the False Claims Act. Enforcement actions span the entire health care supply chain. See our report here in the Anticorruption blog.… Continue Reading
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
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
In 2019 the Department of Justice took off its gloves in the opioid fight. For the second time, DOJ has acted to hold opioid distributors and manufacturers criminally liable for contributing to the drug crisis. Read my analysis here in the Anticorruption blog.… Continue Reading
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
The Department of Justice ramps up enforcement against providers who claim incentives under the Electronic Health Records initiative. Read an update here on our Anticorruption blog.… Continue Reading
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
Policy Shifts at the Department of Justice – 2018 in Review provides an easily navigated yet detailed summary of significant developments at the Department of Justice (DOJ) focusing on fraud and abuse. This Alert sheds light on how the policy shifts may affect the health care industry in the coming year. Among the topics of interest … Continue Reading
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
Many may view a C plea to mean a Corporate Plea. Used infrequently, a C plea restricts discretion of a federal district judge to sentence a criminal defendant. When one federal judge expressed his concerns about a proposed C plea for a pharmaceutical company, he changed the result. In an article published by the American … Continue Reading
The 2017 Year in Review of the Department of Justice reveals a Data Analytics Team (the “Team”) for tracking healthcare fraud. The Healthcare Fraud Unit launched the Team in order to provide data mining expertise that efficiently detects healthcare fraud.… Continue Reading
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
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
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
