In recent years, the federal government has been particularly aggressive in pursuing civil and criminal enforcement against healthcare entities. The way healthcare companies conduct internal investigations so may mean the difference between a manageable resolution and staggering civil or criminal liability.
Continue Reading Key Considerations: How to Conduct an Effective Internal Investigation
Earlier this week, the U.S. Supreme Court solicited input from the Department of Justice (DOJ) regarding the scrutiny with which courts should view False Claims Act complaints—particularly those filed by private plaintiff-relators.
Continue Reading Supreme Court Taking Hard Look at Rule 9(b) Standard
I am looking forward to speaking on a panel at the ABA’s 2022 Virtual Civil False Claims Act and Qui Tam Enforcement Institute titled “Hot Topics 2022: Focus on AKS/Stark” on June 9, 2022 from 1:00 PM – 2:00 PM EST. I will be joined by Gejaa Gobena, Partner, Hogan Lovells, Jennifer Verkamp, Partner, Morgan Verkamp, and Ro Srinivas, Senior Trial Counsel, Department of Justice, Civil Division, Commercial Litigation Branch (Fraud Section).
Continue Reading [Virtual Event] Civil False Claims Act Conference
On May 9, the Department of Justice (DOJ) published its Final Rule on the Civil Monetary Penalties Inflation Adjustment for 2022. This adjustment comes just five months after the last CMP Inflation Adjustment.
Continue Reading DOJ Releases 2022 FCA Civil Monetary Penalties Inflation Adjustment
I was recently interviewed on the Healthcare Strategies podcast about how the Department of Justice (DOJ) is enforcing the Civil Cyber-Fraud Initiative to hold healthcare organizations accountable for cybersecurity matters. The Initiative, launched by DOJ in October 2021, utilizes the False Claims Act (FCA) to take action against entities that knowingly provide insufficient data security measures.
Continue Reading DOJ’s Civil Cyber-Fraud Initiative Impact on Healthcare Organizations
The False Claims Act encourages whistleblowers to come forward when they suspect their employer is committing fraud. This post provides a general overview of the False Claims Act’s anti-retaliation provision, which protects whistleblowers from being retaliated against when they do so.
Continue Reading Anti-Retaliation under the False Claims Act
As previously discussed as a part of our ongoing FCA Fundamentals series, the False Claims Act (FCA) is the federal government’s most important and most effective tool for fighting fraud. While Congress has substantially expanded the scope of the FCA since its inception during the Civil War, courts have recognized that the FCA was “not designed to reach every kind of fraud practiced on the Government” and is not intended to be a “vehicle for punishing garden-variety breaches of contract or regulatory violations.” Rather, the FCA applies only to false or fraudulent claims or omissions that are “material” to the government. So what is materiality?
Continue Reading False Claims Act Fundamentals: What is Materiality?
Scienter is an element that the government or relator must prove to demonstrate a violation of the False Claims Act, 31 U.S.C. § 3729, et seq. Under the False Claims Act, the required scienter, or state of mind, is “knowledge.” In other words, the False Claims Act only penalizes defendants who knowingly submitted false claims, i.e., submitted the false claim with knowledge of the claim’s falsity.
Healthcare is one of the most highly regulated industries in the country and providers of all types will eventually be called to action, whether it be responding to an investigation, conducting a compliance review, or proceeding with a self-disclosure. Bass, Berry & Sims has designed the Healthcare How-To Instructional Webinar Series to provide simple step-by-step instructions and best practices for responding accurately and efficiently while avoiding bad tactics, questionable strategies, and unnecessary risk, which can create problems and less than ideal outcomes.
The False Claims Act, despite its name, does not define what it means for a claim to be “false” or “fraudulent.” This post examines the primary ways courts have interpreted the False Claims Act’s falsity element and discusses common issues that arise concerning falsity.
Continue Reading False Claims Act Fundamentals: What Is a False Claim?