On February 7, the Department of Justice (DOJ) issued a press release indicating that settlements and judgments under the False Claims Act (FCA) exceeded $2.2 billion in the fiscal year ending September 30, 2022. Of this total, over $1.7 billion came from claims involving the healthcare industry.
Continue Reading False Claims Act Settlements to Know from Q1 2023
The third quarter of 2022 brought a number of noteworthy False Claims Act (FCA) settlements, including several over $20 million and one in the high nine figures. This post summarizes key settlements of interest to healthcare providers.
Continue Reading False Claims Act Settlements to Know from Q3 2022
We recently authored an article for ABA Health eSource, published by the American Bar Association’s Health Law Section, that details the expanded focus on cybersecurity activities by the Department of Justice (DOJ) with the Civil Cyber-Fraud initiative.
Continue Reading Expanded Focus on Cybersecurity Activities by DOJ with Civil Cyber-Fraud Initiative
The second quarter of 2022 brought a number of noteworthy False Claims Act (FCA) settlements, including several of $20 million or more. This post summarizes key settlements of interest to healthcare providers.
Continue Reading False Claims Act Settlements to Know from Q2 2022
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
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
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.
Continue Reading [REGISTER NOW] Healthcare How-To Instructional Webinar Series: How to Conduct an Effective Internal Investigation
The False Claims Act, 31 U.S. C. § 3729, et seq., is the federal government’s most important and most effective tool for fighting fraud. This post provides a high-level overview of the False Claims Act and highlights key aspects of this statute.
Continue Reading False Claims Act Fundamentals: What Is the False Claims Act?
There is a new weapon in the Department of Justice’s (DOJ’s) already powerful False Claims Act (FCA) arsenal. In October 2021, the DOJ announced a new Civil Cyber-Fraud Initiative, under which it will pursue FCA liability against government contractors in the cybersecurity space. According to the announcement from Deputy Attorney General Lisa O. Monaco, the initiative seeks to “hold accountable entities or individuals that put U.S. information or systems at risk by knowingly providing deficient cybersecurity products or services, knowingly misrepresenting their cybersecurity protocols, or knowingly violating obligations to monitor and report cybersecurity incidents and breaches.”
The Civil Cyber-Fraud Initiative follows several significant cyberattacks, which are only becoming more prevalent. The new initiative is the first formal step DOJ has taken in combatting them by focusing on the preventative cybersecurity efforts of government contractors.
Continue Reading DOJ Expands False Claims Act Reach into Cybersecurity
For several years, courts have wrestled with the question of whether subjective clinical decisions regarding the type and amount of treatment patients may need can be false for purposes of establishing False Claims Act (FCA) liability. The question of whether the FCA requires a showing of objective falsity has divided appellate courts in a number of recent high-profile cases.
For their part, practitioners have kept a close eye on whether the Supreme Court might bring much-needed clarity to this issue. On February 22, the Supreme Court declined to do so, denying a petition for certiorari with respect to the Third Circuit’s opinion in U.S. ex rel. Druding v. Care Alternatives.
In Druding, the relators, who were former employees of a hospice provider, filed a qui tam action alleging that the hospice provider submitted false claims by routinely certifying patients who were not terminally ill for hospice care. During the litigation, the relators’ expert examined the medical records of nearly 50 patients and concluded that the documentation did not support a certification of terminal illness for approximately 35% of those patients. The hospice provider produced its own expert who testified a physician could have reasonably concluded that the patients at issue were terminally ill and needed hospice care.
Continue Reading Supreme Court Declines to Weigh in on Key Falsity Question