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
Insight on Request for Supreme Court Review of Anti-Kickback Statute’s Scope
I recently provided insight for a Law360 article outlining Pfizer’s request to have the Supreme Court weigh in on the scope of the Anti-Kickback Statute (AKS).
Continue Reading Insight on Request for Supreme Court Review of Anti-Kickback Statute’s Scope
Third Time is Not the Charm – Supreme Court Denies Cert. on Rule 9(b) Split Again
On October 17, the U.S. Supreme Court summarily denied three petitions asking the Court to resolve a growing circuit split on the application of Federal Rule of Civil Procedure 9(b) in False Claims Act lawsuits.
Continue Reading Third Time is Not the Charm – Supreme Court Denies Cert. on Rule 9(b) Split Again
Register Now | 8th Annual Nashville Healthcare Fraud Conference
Please join us for the 8th Annual Nashville Healthcare Fraud Conference hosted by Bass, Berry & Sims and the Tennessee Hospital Association. Eligible for more than seven hours of CLE credit (including ethics), this complimentary program will take place on December 8th in Nashville (full day). The conference will be broadcast virtually the mornings of December 15th and 16th.
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SDNY Ruling in Anthem Sends a Signal to Medicare Advantage Litigants
In a decision issued on September 30, Judge Andrew Carter of the U.S. District Court for the Southern District of New York denied Anthem Inc.’s motion to dismiss a government lawsuit filed in March 2020 claiming Anthem submitted inaccurate diagnosis data in conjunction with its Medicare Part C plans that resulted in alleged overpayments in violation of the False Claims Act (FCA).
Continue Reading SDNY Ruling in Anthem Sends a Signal to Medicare Advantage Litigants
Medicare Advantage Plan Highlights Distinction for FCA Purposes between Clinically Inaccurate Diagnoses and Clinically Accurate Diagnoses that Allegedly Violate Subregulatory Guidelines
In a September 2022 filing in U.S. ex rel. Osinek v. Kaiser Permanente, the Kaiser Permanente consortium defendants (Kaiser) highlighted the distinction between clinically inaccurate diagnoses (factual falsity) and clinically accurate but incorrectly coded diagnoses (legal falsity) and its relevance in False Claims Act (FCA) actions.
Continue Reading Medicare Advantage Plan Highlights Distinction for FCA Purposes between Clinically Inaccurate Diagnoses and Clinically Accurate Diagnoses that Allegedly Violate Subregulatory Guidelines
D.C. Circuit Holds that False Claims Act Damages Must Be Reduced Dollar-for-Dollar by Other Defendants’ Settlements
On August 30, the U.S. Court of Appeals for the D.C. Circuit held, as a matter of first impression, that damages in False Claims Act cases are subject to pro tanto (dollar-for-dollar) settlement offsets in cases involving multiple jointly and severally liable defendants.
Continue Reading D.C. Circuit Holds that False Claims Act Damages Must Be Reduced Dollar-for-Dollar by Other Defendants’ Settlements
Third Circuit Holds that Whistleblower Can Still Be Fired for Misconduct
On August 26, the U.S. Court of Appeals for the Third Circuit issued an order reaffirming that potential False Claims Act (FCA) whistleblowers are not immune from being fired for workplace misconduct, especially where that misconduct involves “oinking” at co-workers.
Continue Reading Third Circuit Holds that Whistleblower Can Still Be Fired for Misconduct
Ninth Circuit Affirms Broad Scope of False Claims Act’s Public Disclosure Bar
On August 25, the U.S. Court of Appeals for the Ninth Circuit issued an opinion in which it held that ex parte patent prosecutions by the Patent and Trademark Office (PTO) qualify as “other Federal . . . hearing[s]” under prong (ii) of the False Claims Act’s Public Disclosure Bar. In so ruling, the Ninth Circuit affirmed that the Public Disclosure Bar should not be read in a restrictive manner but should be given a broad construction.
Continue Reading Ninth Circuit Affirms Broad Scope of False Claims Act’s Public Disclosure Bar
Eighth Circuit Tightens Causation Requirement for FCA Claims Involving Anti-Kickback Statute Violations, Creating Circuit Split
In 2010, Congress amended the Anti-Kickback Statute (AKS) to provide that claims “resulting from” an AKS violation are “false or fraudulent” for False Claims Act (FCA) purposes. 42 U.S.C. § 1320a-7b(g). For over a decade, courts have wrestled with the significance of the “resulting from” requirement and the degree of causation it warrants for an FCA violation premised on an illegal kickback, as we have covered in prior posts.
Continue Reading Eighth Circuit Tightens Causation Requirement for FCA Claims Involving Anti-Kickback Statute Violations, Creating Circuit Split