The FCA continues to be the federal government’s primary civil enforcement tool for investigating allegations that healthcare providers or government contractors defrauded the federal government. In the coming weeks, we are taking a closer look at recent legal developments involving the FCA. This week, we examine recent court decisions considering the level of specificity required of a relator under Rule 9(b) in pleading the alleged FCA fraud scheme.
Continue Reading FCA Deeper Dive: Pleading the Alleged Fraud Scheme
FCA Issues to Watch: FCA Claims Concerning Physician Compensation
Physician employment arrangements with hospitals have remained a significant area of regulatory scrutiny in recent months with the announcement of several high profile settlements and decisions in key FCA cases involving Stark and AKS-related issues.
In July 2016, DOJ announced a $17 million settlement in U.S. ex rel. Hammett v. Lexington County Health Services District. The lawsuit resolved allegations that Lexington County Health Services District, Inc. d/b/a Lexington Medical Center (LMC) in West Columbia, South Carolina violated the Stark Law and FCA by acquiring physician practices and employing physicians on terms that were in excess of fair market value and on terms that were not commercially reasonable.Continue Reading FCA Issues to Watch: FCA Claims Concerning Physician Compensation
FCA Deeper Dive: Rule 9(b) and Pleading Actual Claims
The FCA continues to be the federal government’s primary civil enforcement tool for investigating allegations that healthcare providers or government contractors defrauded the federal government. In the coming weeks, we are taking a closer look at recent legal developments involving the FCA. This week, we examine recent court decisions requiring relators to plead actual claims to satisfy the requirements of Rule 9(b) in order to avoid dismissal.
Federal courts have continued to examine the particularity of the pleading required by Rule 9(b) in the context of FCA claims. Although courts generally agree that a relator must plead the “who, what, when, where, and how” of the alleged fraud, the manner in which courts have applied this standard and the types of allegations considered sufficient to satisfy Rule 9(b) continues to vary significantly.Continue Reading FCA Deeper Dive: Rule 9(b) and Pleading Actual Claims
Bass, Berry & Sims Releases Healthcare Fraud and Abuse Review 2016
Bass, Berry & Sims is pleased to announce the release of its fifth annual Healthcare Fraud and Abuse Review 2016. The Review, compiled by the firm’s Healthcare Fraud Task Force, is an industry-leading guide to healthcare fraud developments and provides an outlook as to what lies ahead in 2017.
The Review details all healthcare-related
Fourth Circuit Takes a Pass on Statistical Sampling, Finds DOJ’s Settlement Veto Authority Unreviewable
After granting the relators’ petition for an interlocutory review of the district court’s rejection of the use of statistical sampling to establish FCA liability, the Fourth Circuit ultimately declined to reach that issue in its opinion recently issued in U.S. ex rel. Michaels v. Agape Senior Community, Inc. This conclusion comes as no surprise based on the comments and questions posed by the panel during the course of oral argument, as we covered here.
Continue Reading Fourth Circuit Takes a Pass on Statistical Sampling, Finds DOJ’s Settlement Veto Authority Unreviewable
U.S. Attorneys for the Middle, Eastern and Western Districts of Tennessee Speak at Nashville Healthcare Fraud Conference
Bass, Berry & Sims and the Tennessee Hospital Association recently sponsored the Nashville Healthcare Fraud Conference, a day-long CLE program designed to provide insight into the most significant fraud and abuse issues facing the healthcare industry. Panel discussions were focused on providing practical tips and takeaways for preparing for, responding to and resolving a healthcare
Matt Curley Analyzes Oral Arguments in Fourth Circuit Agape Case
In an article for Law360, Bass, Berry & Sims attorney Matt Curley provided an analysis of the oral arguments in U.S. ex rel. Michaels v. Agape Senior Community Inc., the Fourth Circuit case closely watched by False Claims Act practitioners. The Fourth Circuit agreed to consider an interlocutory appeal of the district court’s rulings
Seventh Circuit Sidesteps Escobar; Boots FCA Claims for Lack of Knowledge
The Seventh Circuit’s rejection of the implied certification theory of liability gave rise, in part, to the circuit split resolved by the Supreme Court’s opinion in Escobar. In its first FCA decision since the Supreme Court’s opinion – U.S. ex rel. Sheet Metal Workers International Association v. Horning Investments, LLC, the Seventh Circuit sidestepped the question of whether the relator’s allegations that a government contractor’s certification of compliance with the Davis-Bacon Act amounted to an implied false certification sufficient to give rise to FCA liability. Rather than tackle the implications of Escobar, the Seventh Circuit affirmed entry of summary judgment in favor of the contractor, explaining that the defendant’s conduct amounted to certifying compliance with an ambiguous statutory obligation and, therefore, did not constitute a “knowing” violation of the FCA.
Continue Reading Seventh Circuit Sidesteps Escobar; Boots FCA Claims for Lack of Knowledge
U.S. Supreme Court to Resolve Circuit Split on FCA Seal Breaches
Last week, the U.S. Supreme Court granted the petition for writ of certiorari in State Farm Fire and Casualty Co. v. United States ex rel. Rigsby and will consider what standard should determine when a relator’s complaint should be dismissed for violating the FCA’s seal requirement. In Rigsby, former claims adjusters who worked with State Farm after Hurricane Katrina filed suit against the company under § 3730(b), alleging that State Farm misclassified wind damage as flood damage to shift the costs of paying those claims to the federal government. After a jury found that State Farm falsely claimed that damages to a home in Mississippi were caused by flooding, the district court ordered State Farm to pay $758,000 in damages and awarded the relators $227,000. State Farm appealed the verdict, citing the district court’s failure to dismiss the lawsuit despite the district court’s finding that the relators’ attorneys breached the FCA’s seal requirement by disclosing the existence of the case to the media.
Continue Reading U.S. Supreme Court to Resolve Circuit Split on FCA Seal Breaches
Bass, Berry & Sims Releases Healthcare Fraud Year in Review for 2015
Bass, Berry & Sims is pleased to provide its annual Healthcare Fraud and Abuse Review, which highlights significant enforcement trends and legal developments, discusses recent cases and settlements affecting the healthcare industry, and provides an outlook on what lies ahead in 2016.
During the previous year, Bass, Berry & Sims attorneys have represented virtually every