As federal contractors and grant recipients navigate the changing landscape of diversity, equity, and inclusion (DEI) programs, the Trump administration’s rescinding of Executive Order No. 11246 (EO) raises new concerns about potential False Claims Act (FCA) liability for non-compliance.Continue Reading Impact of Trump Administration’s Executive Order on DEI Programs and FCA Liability
Materiality
Fraud and Abuse Chapter of Health Law Handbook, 2024-2025 Edition
By Taylor Chenery, John Eason & Travis Lloyd on
We contributed to the Fraud and Abuse Chapter of the Health Law Handbook, 2024-2025 Edition. In the portion of our content, titled “Healthcare Fraud and Abuse Update,” we outlined regulatory developments, key court decisions and noteworthy settlements related to the Anti-Kickback Statute and Stark Law. Continue Reading Fraud and Abuse Chapter of Health Law Handbook, 2024-2025 Edition
Cyber Incident Reporting May Be “Material” for Federal Contractors
By Taylor Sample on
Last month, the Federal Acquisition Regulatory Council proposed new cybersecurity and incident reporting regulations for federal contractors on behalf of the Department of Defense (DoD), the General Services Administration (GSA), and the National Aeronautics and Space Administration (NASA). Continue Reading Cyber Incident Reporting May Be “Material” for Federal Contractors
Recent False Claims Act Decisions to Know
In this post, we summarize noteworthy False Claims Act (FCA) decisions so far from 2023. Continue Reading Recent False Claims Act Decisions to Know
SDNY Ruling in Anthem Sends a Signal to Medicare Advantage Litigants
By Lindsey Fetzer, Emily Fountain & Julia Tamulis on
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
By Lindsey Fetzer, Emily Fountain & Julia Tamulis on
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
False Claims Act Fundamentals: What is Materiality?
By Nathan Brown on
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?
False Claims Act Decisions to Know from Q1 2022
By Hannah Webber on
There have been several significant rulings on various provisions of the False Claims Act (FCA) in the first quarter of this year, which we highlight in this post.
Continue Reading False Claims Act Decisions to Know from Q1 2022
False Claims Act Fundamentals: Elements of the False Claims Act
By Molly Ruberg on
The False Claims Act, 31 U.S.C. § 3729, et seq. is the federal government’s primary and most effective tool for fighting fraud. This post provides an overview of the elements that plaintiffs must satisfy to establish liability under the False Claims Act and common defenses related to the elements.
Continue Reading False Claims Act Fundamentals: Elements of the False Claims Act
False Claims Act Decisions and Settlements to Know from Q4 2021
By Scott Gallisdorfer on
The final months of 2021 saw a flurry of noteworthy False Claims Act (FCA) activity. Among other developments, appellate courts issued important decisions concerning materiality, the government’s qui tam dismissal authority, and the application of the Eighth Amendment’s Excessive Fines Clause. The fourth quarter also brought news of several significant settlements, including a group of eight- and nine-figure resolutions of alleged Anti-Kickback Statute violations by pharmaceutical manufacturers and the latest example of a private equity firm paying a substantial sum to resolve FCA allegations leveled against one of its portfolio companies.
This post summarizes key developments from the year’s final quarter and identifies important takeaways for healthcare providers and government contractors.Continue Reading False Claims Act Decisions and Settlements to Know from Q4 2021