Anti-Kickback Statute

Download Now – 11th Annual Healthcare Fraud & Abuse ReviewWatch Now | Healthcare Fraud & Abuse Annual Review WebinarFederal Court Rejects Government’s Evidence of Anti-Kickback Statute Violations

Business & Industry Focus

Increased False Claims Act Exposure for Private Equity Firms Investing in HealthcarePPP Enforcement Actions Gather SteamDOJ’s Civil Cyber-Fraud Initiative Impact on Healthcare Organizations

C.C.Cal.

Government Survives Dismissal of Remaining FCA Claims in Managed Care CaseDismissal of Medicare Advantage FCA Suit Marks Significant Defeat for GovernmentSecond DOJ Complaint: Knowledge of Invalid Codes Requires Follow-Through to Avoid Liability

Civil Investigative Demands

False Claims Act Fundamentals: How to Respond to a Civil Investigative DemandAn Ounce of Prevention: Effective Corporate Policies for Dealing with Government Investigations and InquiresDOJ Announces 2019 FCA Recovery, Majority Came from Healthcare Industry

Civil Monetary Penalties

DOJ Releases Annual Civil Fraud Recovery Statistics and ResultsDOJ Releases 2022 FCA Civil Monetary Penalties Inflation AdjustmentEleventh Circuit Becomes First Appeals Court to Hold that Excessive Fines Clause Applies in Declined FCA Cases

Clinical Laboratories

False Claims Act Settlements to Know from Q1 2022

Complaints

Third Time is Not the Charm – Supreme Court Denies Cert. on Rule 9(b) Split AgainEighth Circuit Affirms Dismissal of Kickback CaseGovernment Files Amended FCA Complaint Against Private Equity Firm and its Portfolio Company

Compliance

Download Now – 11th Annual Healthcare Fraud & Abuse ReviewRegister Now | 8th Annual Nashville Healthcare Fraud ConferenceSecond Circuit Agrees that the Anti-Kickback Statute Does Not Contain a “Corruption” Element

Damages

D.C. Circuit Holds that False Claims Act Damages Must Be Reduced Dollar-for-Dollar by Other Defendants’ SettlementsFalse Claims Act Fundamentals: DamagesDOJ Releases 2022 FCA Civil Monetary Penalties Inflation Adjustment

Discovery

False Claims Act Amendments Take More Direct Attack at Escobar and Pass Senate Judiciary CommitteeChanges Coming to the FCA?  Proposed Amendments Would Impact Materiality Analysis, Government Discovery, Among Other Issues

Enforcement

DOJ Releases Annual Civil Fraud Recovery Statistics and ResultsRegister Now | 8th Annual Nashville Healthcare Fraud ConferenceGovernment Announces First FCA Settlement with PPP Lender

Escobar

SDNY Ruling in Anthem Sends a Signal to Medicare Advantage LitigantsFalse Claims Act Fundamentals:  What is Materiality?False Claims Act Fundamentals: What Is a False Claim?

Events

Watch Now | Healthcare Fraud & Abuse Annual Review WebinarRegister Now | 8th Annual Nashville Healthcare Fraud ConferenceWatch On-Demand | How to Submit a Stark Law Self-Disclosure Webinar

Express/Implied Certification

False Claims Act Fundamentals: What Is a False Claim?FCA Deeper Dive: Express CertificationNorth District of California Misconstrues Express False Certification Liability

False Certification

PPP Enforcement Actions Gather SteamFalse Claims Act Fundamentals: What Is a False Claim?PPP Investigations, Settlements and Litigation on the Horizon

False Statements

Qui Tam Complaint Against Pharmacy Dismissed for Lack of ParticularityJeff Gibson Outlines Investigative Tools in FCA CasesFCA Deeper Dive: Worthless Services as a Theory of Falsity

Falsity

Medicare Advantage Plan Highlights Distinction for FCA Purposes between Clinically Inaccurate Diagnoses and Clinically Accurate Diagnoses that Allegedly Violate Subregulatory GuidelinesFalse Claims Act Fundamentals: What Is a False Claim?Fifth Circuit Affirms Criminal Healthcare Fraud Convictions of Hospice and Home Health Executives

FCA Alert

Download Now – 11th Annual Healthcare Fraud & Abuse ReviewDOJ Releases Annual Civil Fraud Recovery Statistics and ResultsSecond Circuit Holds False Claims Act Complaint Is Barred by SEC Filings

FCA Deep Dive

Supreme Court Taking Hard Look at Rule 9(b) StandardTennessee Healthcare Fraud and Abuse LawsFourth Circuit Adopts Safeco’s Objective Reasonableness Standard for False Claims Act

FCA Fundamentals

False Claims Act Fundamentals: Reverse False ClaimsWatch Now | Healthcare Fraud & Abuse Annual Review WebinarJudge Chen’s Message to Medicare Advantage Providers: ICD Guidelines Aren’t Suggestions

First-to-File

False Claims Act Decisions to Know from Q1 2022False Claims Act Fundamentals: What Is a Relator?  Corporate Maneuvering Leads to Thorny First-to-File Bar Issues

Government Contracts

Government Announces First FCA Settlement with PPP LenderPPP Enforcement Actions Gather SteamFalse Claims Act Fundamentals: Anti-Kickback Statute and the Stark Law

Granston Memo

Impact of Supreme Court’s Escobar Decision on Fifth AnniversaryDistrict Courts Hold that DOJ Lacks “Unfettered” Discretion to Preemptively Dismiss Qui Tam ActionsSupreme Court Asked to Review Pleading Standard and Constitutionality of FCA

HITECH Act

Electronic Health Records Vendor Must Pay Over $150 Million in FCA SettlementSixth Circuit Affirms Dismissal of FCA Action Related to HITECH Meaningful Use Payments

Hospice

Fifth Circuit Affirms Criminal Healthcare Fraud Convictions of Hospice and Home Health ExecutivesHospice Fraud: Eleventh Circuit Court’s FCA Decision in AseraCareUpdate: Healthcare Fraud Cases Against Hospice Providers

Hospitals

Seventh Circuit Signals Ongoing Importance of Compliance with Medicare “Bad Debt” RegulationsFalse Claims Act Settlements to Know from Q2 2022False Claims Act Settlements to Know from Q1 2022

Implied Certification

Supreme Court Review Sought on FCA Materiality, Scienter ElementsNo Consensus on Materiality: Courts Continue to Grapple with Escobar’s Key HoldingsNinth Circuit Holds that Escobar Set Forth Exclusive Conditions for Implied Certification Liability

Intent

Second Circuit Agrees that the Anti-Kickback Statute Does Not Contain a “Corruption” ElementFourth Circuit Adopts Safeco’s Objective Reasonableness Standard for False Claims ActDeeper Dive: Meeting the FCA’s Intent Requirement

Knowledge/Scienter

Supreme Court Review of False Claims Act Scienter StandardFalse Claims Act Fundamentals: ScienterFalse Claims Act Fundamentals: Elements of the False Claims Act

Long-Term Care

Increased Oversight of Long-Term Care Facilities Related to COVID-19Healthcare Fraud Enforcement in Long-Term Care IndustryTennessee Nursing Home Chain Reaches “Largest Worthless Services Resolution in Tennessee’s History”

Managed Care

Watch Now | Healthcare Fraud & Abuse Annual Review WebinarCMS Proposed Rule Addresses Multiple Aspects of Medicare Advantage Program for 2024, Including an Overpayment Rule UpdateSDNY Ruling in Anthem Sends a Signal to Medicare Advantage Litigants

Materiality

SDNY Ruling in Anthem Sends a Signal to Medicare Advantage LitigantsMedicare Advantage Plan Highlights Distinction for FCA Purposes between Clinically Inaccurate Diagnoses and Clinically Accurate Diagnoses that Allegedly Violate Subregulatory GuidelinesFalse Claims Act Fundamentals:  What is Materiality?

Medical Necessity

False Claims Act Fundamentals: What Is a False Claim?Fifth Circuit Affirms Criminal Healthcare Fraud Convictions of Hospice and Home Health ExecutivesThe Eliminating Kickbacks in Recovery Act: An Unprecedented Expansion of Anti-kickback Liability to Private-Pay Referrals?

Medicare Advantage

DOJ Focus on Medicare Advantage Insurers and FCA LiabilityCMS Proposed Rule Addresses Multiple Aspects of Medicare Advantage Program for 2024, Including an Overpayment Rule UpdateSDNY Ruling in Anthem Sends a Signal to Medicare Advantage Litigants

Medicare/Medicaid

Watch On-Demand | How to Submit a Stark Law Self-Disclosure WebinarSeventh Circuit Signals Ongoing Importance of Compliance with Medicare “Bad Debt” RegulationsCourt Decision Upholding OIG’s Rejection of Pharmaceutical Company’s Drug Co-Pay Assistance Program

Original Source

Public Disclosure Bar and Pleading Deficiencies Doom Tennessee FCA CaseEleventh Circuit Holds Secondhand Knowledge Does Not Make Relator an Original SourceFCA Deeper Dive: Original Sources under the FCA’s Public Disclosure Bar

Overpayments

DOJ Focus on Medicare Advantage Insurers and FCA LiabilityProvider Beware: Recent FCA Cases Emphasize the Importance of Diligently Addressing Potential OverpaymentsMedicare Advantage: Recent Developments in FCA Enforcement

Penalties

False Claims Act Fundamentals: DamagesDOJ Releases 2022 FCA Civil Monetary Penalties Inflation AdjustmentEleventh Circuit Becomes First Appeals Court to Hold that Excessive Fines Clause Applies in Declined FCA Cases

Pharmaceutical Manufacturers

Second Circuit Agrees that the Anti-Kickback Statute Does Not Contain a “Corruption” ElementCourt Decision Upholding OIG’s Rejection of Pharmaceutical Company’s Drug Co-Pay Assistance ProgramThe California Insurance Frauds Prevention Act: What to Know About California’s Powerful Commercial Health Insurance Fraud Statute

Pharmaceuticals

Download Now – 11th Annual Healthcare Fraud & Abuse ReviewRegister Now | 8th Annual Nashville Healthcare Fraud ConferenceSecond Circuit Agrees that the Anti-Kickback Statute Does Not Contain a “Corruption” Element

Physician Compensation

Register Now | 8th Annual Nashville Healthcare Fraud ConferenceUpdate: Third Circuit Allows Allegations of Improper Compensation under the Stark Law to Proceed, but Reverses Controversial "Varies with Volume or Value" ReasoningThird Circuit Holds Allegations of Improper Compensation Methodologies under the Stark Law Survive Motion to Dismiss

Physicians

False Claims Act Settlements to Know from Q2 2022False Claims Act Settlements to Know from Q1 2022SC Hospital Pays $17 Million to Resolve FCA Claims of Improper Physician Employment Relationships

Pleading Standards

Anti-Retaliation under the False Claims ActFourth Circuit Adopts Safeco’s Objective Reasonableness Standard for False Claims ActEighth Circuit Affirms Dismissal of Kickback Case

Public Disclosure Bar

Second Circuit Holds False Claims Act Complaint Is Barred by SEC FilingsNinth Circuit Affirms Broad Scope of False Claims Act’s Public Disclosure BarFalse Claims Act Fundamentals: What Is a Relator?  

Publications

Download Now – 11th Annual Healthcare Fraud & Abuse ReviewDownload Now – 10th Annual Healthcare Fraud & Abuse ReviewDownload and Register Now - Healthcare Fraud & Abuse Review and Webinar from Bass, Berry & Sims

Quarterly Case & Settlement Updates

False Claims Act Settlements to Know from Q3 2022False Claims Act Settlements to Know from Q2 2022False Claims Act Settlements to Know from Q1 2022

Relators

Supreme Court Review of Key FCA IssuesFalse Claims Act Fundamentals: What Is a Relator?  False Claims Act Decisions and Settlements to Know from Q4 2021

Reports

Download Now – 11th Annual Healthcare Fraud & Abuse ReviewDownload Now – 10th Annual Healthcare Fraud & Abuse ReviewRegister Now for the Healthcare Fraud & Abuse Review Webinar

Retaliation

Third Circuit Holds that Whistleblower Can Still Be Fired for MisconductAnti-Retaliation under the False Claims ActFalse Claims Act Fundamentals: What Is a Relator?  

Reverse False Claims

False Claims Act Fundamentals: Reverse False ClaimsProvider Beware: Recent FCA Cases Emphasize the Importance of Diligently Addressing Potential OverpaymentsQui Tam Complaint Against Pharmacy Dismissed for Lack of Particularity

Rule 9(b)

Supreme Court Review of Key FCA IssuesThird Time is Not the Charm – Supreme Court Denies Cert. on Rule 9(b) Split AgainUnited States Says No Supreme Court Review Needed in False Claims Act Cases

Seal Requirement

Relator Cannot Maintain Dismissed Qui Tam Action Under Seal, District Court Rules“Significant Abuses of the Statutory Scheme:" District Court Criticizes Practice of Regular Extensions of the FCA Seal PeriodSupreme Court Rejects Mandatory Dismissal for an FCA Seal Breach

Self-Disclosure

False Claims Act Fundamentals: Self-DisclosuresRegister Now | 8th Annual Nashville Healthcare Fraud ConferenceWatch On-Demand | How to Submit a Stark Law Self-Disclosure Webinar

Settlement

DOJ Releases Annual Civil Fraud Recovery Statistics and ResultsD.C. Circuit Holds that False Claims Act Damages Must Be Reduced Dollar-for-Dollar by Other Defendants’ Settlements2021 Recap: Hospitals’ Significant False Claims Act Settlements

Stark Law

Download Now – 11th Annual Healthcare Fraud & Abuse ReviewWatch On-Demand | How to Submit a Stark Law Self-Disclosure WebinarFalse Claims Act Fundamentals: Anti-Kickback Statute and the Stark Law

State and Other Supreme Courts

FCA Deeper Dive: Escobar and Its Aftermath – Part I

State/Local FCA

Download Now – 11th Annual Healthcare Fraud & Abuse ReviewTennessee Healthcare Fraud and Abuse LawsDownload Now – 10th Annual Healthcare Fraud & Abuse Review

Statistical Sampling

False Claims Act Dangers on Display in RuckhFourth Circuit Takes a Pass on Statistical Sampling, Finds DOJ's Settlement Veto Authority UnreviewableMatt Curley Analyzes Oral Arguments in Fourth Circuit Agape Case

Statute of Limitations

Supreme Court Wrestles with “Terribly Drafted” FCA Statute of LimitationsSupreme Court Agrees to Resolve Circuit Split on FCA Statute of LimitationsSupreme Court Limits WSLA to Criminal Offenses

United States Supreme Court

Supreme Court Review of Key FCA IssuesSupreme Court Review of False Claims Act Scienter StandardThird Time is Not the Charm – Supreme Court Denies Cert. on Rule 9(b) Split Again

Whistleblower

Supreme Court Review of Key FCA IssuesFalse Claims Act Fundamentals: What Is a Relator?  False Claims Act Fundamentals: What Is the False Claims Act?

Worthless Services

Tennessee Nursing Home Chain Reaches “Largest Worthless Services Resolution in Tennessee’s History”The Eliminating Kickbacks in Recovery Act: An Unprecedented Expansion of Anti-kickback Liability to Private-Pay Referrals?FCA Deeper Dive: Worthless Services as a Theory of Falsity

Yates Memo

Associate Attorney General Sheds Light on the DOJ’s Application of Individual Liability and Corporate Cooperation Credit in FCA casesA Look Back at Healthcare Fraud Enforcement Efforts from 2015

From the Bass, Berry & Sims Blog Network
From the Bass, Berry & Sims Blog Network

Thought Leadership by our Attorneys.