Search results for: 9(b)

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 will take 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.

In the past, the First Circuit has shifted between requiring the identification of a specific false claim and applying a more flexible standard. Compare U.S. ex rel. Karvelas v. Melrose-Wakefield Hosp., 360 F.3d 220, 232 (1st Cir. 2004) (applying strict standard) abrogated on other grounds, Allison Engine Co. v. U.S. ex rel. Sanders, 553 U.S. 662 (2008), with U.S. ex rel. Duxbury v. Ortho Biotech Prods., L.P., 579 F.3d 13, 29 (1st Cir. 2009) (applying flexible standard). Last year, the First Circuit explained its approach as requiring “relators to connect allegations of fraud to particular false claims for payment, rather than a fraudulent scheme in the abstract.”Continue Reading FCA Deeper Dive: Rule 9(b) and the Pleading of Actual Claims

It is not every day that an 83-page qui tam complaint alleging Stark Law and Anti-Kickback Statute (AKS) violations is dismissed at the pleading stage, particularly when filed by experienced relator’s counsel and accompanied by more than 30 pages of detailed claims data.  But that was exactly the result in U.S. ex rel. Kyer v. Thomas Health System, a June 4 decision from a unanimous Fourth Circuit panel.

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Continue Reading Smoke is Not Fire: Fourth Circuit Rejects Stark and AKS Theories Built on Ordinary Business Practices and Conclusory Allegations

In Wisconsin Bell, Inc. v. United States ex rel. Heath, the Supreme Court clarified the definition of “claim” under the FCA. The case resolves a split between the Fifth and Seventh Circuits on whether a request for reimbursement under the E-Rate subsidies program meets the statutory definition of a “claim.”

Continue Reading Supreme Court Clarifies “Claim” Definition Under False Claims Act

On August 6, the U.S. Court of Appeals for the Second Circuit issued a significant opinion that clarifies the requirements for pleading a reverse false claim under the False Claims Act (FCA).

Continue Reading Second Circuit Addresses “Obligation” Requirement of False Claims Act’s Reverse False Claim Provision

Bass Berry & Sims recently secured dismissals on behalf of healthcare providers in three separate False Claims Act (FCA) qui tam lawsuits in a matter of a week’s time.

Continue Reading Bass, Berry & Sims Notches Wins for Clients in Trio of False Claims Act Qui Tam Lawsuits

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

In a recent decision, U.S. ex rel. Sibley v. Univ. of Chicago Medical Center, the U.S. Court of Appeals for the Seventh Circuit considered allegations that two medical billing and debt collection companies, Medical Business Office Corp. (MBO) and Trustmark Recovery Services, Inc. (Trustmark), and the University of Chicago Medical Center (UCMC), a client of one of the debt collection companies, violated the False Claims Act (FCA) by seeking inappropriate reimbursement from the Centers for Medicare and Medicaid Services (CMS) for Medicare “bad debts.”
Continue Reading Seventh Circuit Signals Ongoing Importance of Compliance with Medicare “Bad Debt” Regulations

Last week, we posted about the U.S. Supreme Court’s request for input from the Solicitor General on how False Claim Act complaints should be reviewed by courts.

Currently, the plaintiff-relators in two cases—U.S. ex rel. Owsley v. Fazzi Associates, Inc. and Johnson v. Bethany Hospice & Palliative Care, LLC—have submitted petitions for certiorari asking the Supreme Court to resolve what they see as a “long-standing circuit split” on the application of Rule 9(b) in False Claims Act cases.

In the Bethany Hospice case, which was the first to submit a petition, the plaintiff-relator argued that her complaint was dismissed under the Eleventh Circuit’s “rigid” application of Rule 9(b), which in most cases requires the specific details of at least one false claim that was actually submitted to the government, but that her complaint would have easily survived dismissal in many other circuits that only require “reliable indicia” that such claims were submitted.Continue Reading United States Says No Supreme Court Review Needed in False Claims Act Cases

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From the Bass, Berry & Sims Blog Network

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