I was recently interviewed on the Healthcare Strategies podcast about how the Department of Justice (DOJ) is enforcing the Civil Cyber-Fraud Initiative to hold healthcare organizations accountable for cybersecurity matters. The Initiative, launched by DOJ in October 2021, utilizes the False Claims Act (FCA) to take action against entities that knowingly provide insufficient data security measures.
Continue Reading DOJ’s Civil Cyber-Fraud Initiative Impact on Healthcare Organizations
Recently, I was interviewed on the Healthcare Strategies podcast about how the Department of Justice (DOJ) is enforcing the Civil Cyber-Fraud Initiative to hold healthcare organizations accountable for cybersecurity matters.
Continue Reading DOJ’s Civil Cyber-Fraud Initiative Impact on Healthcare Organizations
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.
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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?
Scienter is an element that the government or relator must prove to demonstrate a violation of the False Claims Act, 31 U.S.C. § 3729, et seq. Under the False Claims Act, the required scienter, or state of mind, is “knowledge.” In other words, the False Claims Act only penalizes defendants who knowingly submitted false claims, i.e., submitted the false claim with knowledge of the claim’s falsity.
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.
The False Claims Act, despite its name, does not define what it means for a claim to be “false” or “fraudulent.” This post examines the primary ways courts have interpreted the False Claims Act’s falsity element and discusses common issues that arise concerning falsity.
Continue Reading False Claims Act Fundamentals: What Is a False Claim?
The first quarter of 2022 brought news of several noteworthy False Claims Act (FCA) settlements, including several settlements by physicians regarding arrangements deemed to be unlawful kickbacks and the first settlement under the Department of Justice’s Civil Cyber-Fraud Initiative. This post summarizes key settlements of interest to healthcare providers and government contractors.
Continue Reading False Claims Act Settlements to Know from Q1 2022
On March 24, the U.S. Court of Appeals for the Fifth Circuit affirmed the criminal healthcare fraud convictions of two individuals who ran a network of home health and hospice centers in Texas. According to the Fifth Circuit, the defendants operated a “reimburse-first-verify-later system” for nearly ten years, under which an estimated 70 to 85 percent of patients were ineligible for the care they received. The Fifth Circuit provided colorful examples to show that “many certifications were not borderline cases”:
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