Last week, the U.S. Department of Justice (DOJ) announced a $22.4 million settlement resolving allegations that Martin’s Point Health Care, Inc. (Martin’s Point) violated the False Claims Act (FCA) by submitting inaccurate diagnosis codes for its Medicare Advantage Plan enrollees. Continue Reading Martin’s Point Health Care Inc.’s $22.4M Settlement Illustrates DOJ’s Focus on Part C Fraud
Expect More Cyber-Enforcement under the False Claims Act
Earlier this month, the White House released the National Cybersecurity Strategy Implementation Plan outlining specific “high impact initiatives” that the federal government will carry out to achieve its cybersecurity objectives. Continue Reading Expect More Cyber-Enforcement under the False Claims Act
CMS Publishes New Data on Self-Referral Disclosure Protocol Settlements
The Centers for Medicare & Medicaid Services (CMS) recently published updated data regarding settlements made under the Voluntary Self-Referral Disclosure Protocol (SRDP), an important mechanism through which providers may disclose actual or potential violations of the federal physician self-referral prohibition commonly known as the Stark Law. Continue Reading CMS Publishes New Data on Self-Referral Disclosure Protocol Settlements
Supreme Court Upholds Broad Government Authority to Dismiss Qui Tam False Claims Act Lawsuits
On June 16, the U.S. Supreme Court issued its opinion in U.S. ex rel. Polansky v. Executive Health Resources, a closely watched case about the government’s power to dismiss a False Claims Act (FCA) qui tam lawsuit over a relator’s objection.Continue Reading Supreme Court Upholds Broad Government Authority to Dismiss Qui Tam False Claims Act Lawsuits
Supreme Court Rejects Safeco, Holds that FCA Scienter Turns on Defendant’s Subjective Belief
On June 1, the U.S. Supreme Court unanimously refused to apply the Safeco objective knowledge standard to the False Claims Act (FCA), holding instead in U.S. ex rel. Schutte v. Supervalu Inc. that the FCA’s scienter element turns on a defendant’s “knowledge and subjective beliefs,” not on “what an objectively reasonable person may have known or believed.”Continue Reading Supreme Court Rejects Safeco, Holds that FCA Scienter Turns on Defendant’s Subjective Belief
Sixth Circuit Reins In Anti-Kickback Statute
On March 28, the Sixth Circuit issued an important decision on the meanings of “remuneration” and “causation” under the Anti-Kickback Statute (AKS), holding that remuneration “covers just payments and other transfers of value” and not “any act that may be valuable to another,” and that to establish False Claims Act (FCA) liability based on AKS violations, a relator or the government must prove a causal link between the alleged kickback scheme and the alleged false claim. Continue Reading Sixth Circuit Reins In Anti-Kickback Statute
Download Now – 11th Annual Healthcare Fraud & Abuse Review
Bass, Berry & Sims is pleased to announce the release of the 11th annual Healthcare Fraud & Abuse Review examining important healthcare fraud developments in 2022. Continue Reading Download Now – 11th Annual Healthcare Fraud & Abuse Review
DOJ Releases Annual Civil Fraud Recovery Statistics and Results
On February 7, the Department of Justice (DOJ) released its annual report of civil fraud recoveries for the prior fiscal year, along with its accompanying press release highlighting its civil enforcement efforts. Our top ten observations from DOJ’s release include:Continue Reading DOJ Releases Annual Civil Fraud Recovery Statistics and Results
Second Circuit Holds False Claims Act Complaint Is Barred by SEC Filings
In July 2021, the U.S. District Court for the Eastern District of New York dismissed a False Claims Act complaint filed by CKD Project, LLC, an entity created for the purpose of filing the lawsuit, which alleged that Fresenius violated the federal Anti-Kickback Statute by over-paying physicians for a majority interest in certain dialysis centers in exchange for the physicians’ continued referrals. Continue Reading Second Circuit Holds False Claims Act Complaint Is Barred by SEC Filings
Federal Court Rejects Government’s Evidence of Anti-Kickback Statute Violations
Earlier this month, the U.S. District Court for the Northern District of Georgia entered an order critiquing the government’s lack of evidence in a criminal case alleging violations of the Anti-kickback Statute (AKS).
Continue Reading Federal Court Rejects Government’s Evidence of Anti-Kickback Statute Violations