Topics

Anti-Kickback Statute

False Claims Act Enforcement in Healthcare: Insights from the 13th Annual Fraud & Abuse ReviewDownload Now – 13th Annual Healthcare Fraud & Abuse ReviewRegister Now | Healthcare Fraud & Abuse Annual Review Webinar

Business & Industry Focus

New False Claims Act Settlement Highlights Importance of Voluntary Self-Disclosures and Due DiligenceDOJ Settlement Highlights Customs, FCA Risks for ImportersRegister Now: 10th Annual Nashville Healthcare Fraud Conference | December 12-13

C.C. Ill.

Recent Developments in FCA Pleading Standards – Part One

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

Causation

DOJ Settlement Highlights Customs, FCA Risks for ImportersFirst Circuit Adopts “But-For” Causation Standard for Proving Kickback FCA ViolationsGrowing Divide for Causation Standard Under the Anti-Kickback Statute

Civil Investigative Demands

Impact of Trump Administration’s Executive Order on DEI Programs and FCA LiabilityRegister Now | How to Respond to a Civil Investigative Demand WebinarFalse Claims Act Fundamentals: How to Respond to a Civil Investigative Demand

Civil Monetary Penalties

New False Claims Act Settlement Highlights Importance of Voluntary Self-Disclosures and Due DiligenceDOJ Settlement Highlights Customs, FCA Risks for ImportersImpact of Trump Administration’s Executive Order on DEI Programs and FCA Liability

Clinical Laboratories

Seoul Medical Group and Renaissance Imaging Medical Associates Settle Medicare Risk Adjustment Fraud Case for $62 MillionExecutive Order on DEI Programs: Implications for Healthcare and False Claims Act RisksSettlement Roundup: Heart-Valve Replacements, Federal Research Grants, and Clinical Laboratory Marketing

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

Key Takeaways from DOJ’s Continued Cybersecurity EnforcementFalse Claims Act Gives Broad Dismissal Authority to Government, District Judge SaysNew False Claims Act Settlement Highlights Importance of Voluntary Self-Disclosures and Due Diligence

Counterclaims

False Claims Act Gives Broad Dismissal Authority to Government, District Judge Says

Courts

False Claims Act Gives Broad Dismissal Authority to Government, District Judge Says

COVID-19

The Surge in FCA Whistleblower Lawsuits: What’s Driving the Trend and What Comes Next?COVID-19 Relief ScrutinySeries on Healthcare Fraud Risk for The Compliance & Ethics Blog

Cybersecurity

Key Takeaways from DOJ’s Continued Cybersecurity EnforcementUnited States Files First Complaint Under the Civil Cyber-Fraud InitiativeSeries on Healthcare Fraud Risk for The Compliance & Ethics Blog

Damages

Impact of Trump Administration’s Executive Order on DEI Programs and FCA LiabilityDOJ Brings Nationwide False Claims Act Lawsuit Against CVS for Alleged Violations of Controlled Substances ActFraud and Abuse Chapter of Health Law Handbook, 2024-2025 Edition

Discovery

False Claims Act Fundamentals: How to Respond to a Third-Party SubpoenaFalse 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

District of Vermont

Electronic Health Records Company Pays High Price for Software Shortcomings

Electronic Health Records

First False Claims Act Settlement under DOJ’s Cyber-Fraud InitiativeElectronic Health Records Company Pays High Price for Software Shortcomings

Enforcement

Potential Shift in Healthcare Fraud OversightDOJ Settlement Highlights Customs, FCA Risks for ImportersSeoul Medical Group and Renaissance Imaging Medical Associates Settle Medicare Risk Adjustment Fraud Case for $62 Million

Escobar

Cyber Incident Reporting May Be “Material” for Federal ContractorsSDNY Ruling in Anthem Sends a Signal to Medicare Advantage LitigantsFalse Claims Act Fundamentals:  What is Materiality?

Events

Register Now | Healthcare Fraud & Abuse Annual Review WebinarRegister Now: 10th Annual Nashville Healthcare Fraud Conference | December 12-13Watch Now | Legal Rx: How to Navigate Controlled Substances Enforcement & Diversion 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

DOJ Settlement Highlights Customs, FCA Risks for ImportersPPP Enforcement Actions Gather SteamFalse Claims Act Fundamentals: What Is a False Claim?

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

DOJ Settlement Highlights Customs, FCA Risks for ImportersFraud and Abuse Chapter of Health Law Handbook, 2024-2025 EditionControlled Substances Act and False Claims Act Collide

FCA Alert

District Court Blocks Department of Labor Enforcement of Contractor DEI Certification RequirementDOJ Settlement Highlights Customs, FCA Risks for ImportersSeoul Medical Group and Renaissance Imaging Medical Associates Settle Medicare Risk Adjustment Fraud Case for $62 Million

FCA Deep Dive

Download Now – 13th Annual Healthcare Fraud & Abuse ReviewHHS-OIG Year in Review 2024Use of Data in False Claims Act Cases and Other Litigation

FCA Fundamentals

Register Now | Healthcare Fraud & Abuse Annual Review WebinarRegister Now | Healthcare Fraud & Abuse Annual Review Webinar ReplayRegister Now | Healthcare Fraud & Abuse Annual Review Webinar

FCPA

DOJ Settlement Highlights Customs, FCA Risks for Importers

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

District Court Blocks Department of Labor Enforcement of Contractor DEI Certification RequirementKey Takeaways from DOJ’s Continued Cybersecurity EnforcementFalse Claims Act Gives Broad Dismissal Authority to Government, District Judge Says

Government Knowledge

Impact of Trump Administration’s Executive Order on DEI Programs and FCA Liability

Granston Memo

False Claims Act Gives Broad Dismissal Authority to Government, District Judge SaysImpact of Supreme Court’s Escobar Decision on Fifth AnniversaryDistrict Courts Hold that DOJ Lacks “Unfettered” Discretion to Preemptively Dismiss Qui Tam Actions

Healthcare Providers

Seoul Medical Group and Renaissance Imaging Medical Associates Settle Medicare Risk Adjustment Fraud Case for $62 MillionFalse Claims Act Enforcement in Healthcare: Insights from the 13th Annual Fraud & Abuse ReviewThe Surge in FCA Whistleblower Lawsuits: What’s Driving the Trend and What Comes Next?

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

Potential Shift in Healthcare Fraud OversightFalse Claims Act Enforcement in Healthcare: Insights from the 13th Annual Fraud & Abuse ReviewImpact of Trump Administration’s Executive Order on DEI Programs and FCA Liability

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

False Claims Act Decisions to Know from Q3 2024Second Circuit Agrees that the Anti-Kickback Statute Does Not Contain a “Corruption” ElementFourth Circuit Adopts Safeco’s Objective Reasonableness Standard for False Claims Act

Knowledge/Scienter

False Claims Act Gives Broad Dismissal Authority to Government, District Judge SaysImpact of Trump Administration’s Executive Order on DEI Programs and FCA LiabilityFalse Claims Act Application in Nevada Worker Classification Fight Against Lyft

Legislation

Impact of Trump Administration’s Executive Order on DEI Programs and FCA LiabilityExecutive Order on DEI Programs: Implications for Healthcare and False Claims Act Risks

Long-Term Care

Drug Diversion within Long-Term Care IndustryIncreased Oversight of Long-Term Care Facilities Related to COVID-19Healthcare Fraud Enforcement in Long-Term Care Industry

Managed Care

Martin’s Point Health Care Inc.’s $22.4M Settlement Illustrates DOJ’s Focus on Part C FraudWatch Now | Healthcare Fraud & Abuse Annual Review WebinarCMS Proposed Rule Addresses Multiple Aspects of Medicare Advantage Program for 2024, Including an Overpayment Rule Update

Materiality

Impact of Trump Administration’s Executive Order on DEI Programs and FCA LiabilityFraud and Abuse Chapter of Health Law Handbook, 2024-2025 EditionCyber Incident Reporting May Be “Material” for Federal Contractors

Medical Necessity

Seoul Medical Group and Renaissance Imaging Medical Associates Settle Medicare Risk Adjustment Fraud Case for $62 MillionSettlement Roundup: Heart-Valve Replacements, Federal Research Grants, and Clinical Laboratory MarketingFalse Claims Act Fundamentals: What Is a False Claim?

Medicare Advantage

Seoul Medical Group and Renaissance Imaging Medical Associates Settle Medicare Risk Adjustment Fraud Case for $62 MillionMartin’s Point Health Care Inc.’s $22.4M Settlement Illustrates DOJ’s Focus on Part C FraudDOJ Focus on Medicare Advantage Insurers and FCA Liability

Medicare/Medicaid

False Claims Act Enforcement in Healthcare: Insights from the 13th Annual Fraud & Abuse ReviewImpact of Trump Administration’s Executive Order on DEI Programs and FCA LiabilityExecutive Order on DEI Programs: Implications for Healthcare and False Claims Act Risks

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

False Claims Act Enforcement in Healthcare: Insights from the 13th Annual Fraud & Abuse ReviewDOJ Focus on Medicare Advantage Insurers and FCA LiabilityProvider Beware: Recent FCA Cases Emphasize the Importance of Diligently Addressing Potential Overpayments

Penalties

Impact of Trump Administration’s Executive Order on DEI Programs and FCA LiabilityFalse Claims Act Fundamentals: DamagesDOJ Releases 2022 FCA Civil Monetary Penalties Inflation Adjustment

Pharmaceutical Manufacturers

False Claims Act Enforcement in Healthcare: Insights from the 13th Annual Fraud & Abuse ReviewSecond 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 Program

Pharmaceuticals

False Claims Act Enforcement in Healthcare: Insights from the 13th Annual Fraud & Abuse ReviewDownload Now – 13th Annual Healthcare Fraud & Abuse ReviewRite Aid and OptumRx Settlements Highlight Enforcement Focus on Pharmacy Corresponding Responsibility for Dispensing Controlled Substances

Physician Compensation

False Claims Act Enforcement in Healthcare: Insights from the 13th Annual Fraud & Abuse ReviewRegister 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" Reasoning

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

Fourth Circuit Holds that Violation of CIA Can Support Reverse False Claims and Adopts Relaxed Rule 9(b) Presentment RequirementFalse Claims Act Decisions to Know from Q3 2024Anti-Retaliation under the False Claims Act

Private Equity

Controlled Substances Act and False Claims Act CollideIncreased False Claims Act Exposure for Private Equity Firms Investing in HealthcareFalse Claims Act Decisions and Settlements to Know from Q4 2021

Public Disclosure Bar

Impact of Trump Administration’s Executive Order on DEI Programs and FCA LiabilityRecent False Claims Act Decisions to KnowSecond Circuit Holds False Claims Act Complaint Is Barred by SEC Filings

Publications

Download Now – 13th Annual Healthcare Fraud & Abuse ReviewDownload Now – 12th Annual Healthcare Fraud & Abuse ReviewDownload Now – 11th Annual Healthcare Fraud & Abuse Review

Quarterly Case & Settlement Updates

False Claims Act Decisions to Know from Q3 2024False Claims Act Settlements to Know from Q3 2024False Claims Act Decisions to Know from Q2 2024

Relators

False Claims Act Gives Broad Dismissal Authority to Government, District Judge SaysDOJ Releases Annual Civil Fraud Recovery Statistics and Results… Our Look Behind the NumbersImpact of New False Claims Act Qui Tam Ruling

Reports

Download Now – 13th Annual Healthcare Fraud & Abuse ReviewDownload Now – 12th Annual Healthcare Fraud & Abuse ReviewDownload Now – 11th Annual Healthcare Fraud & Abuse Review

Retaliation

Impact of Trump Administration’s Executive Order on DEI Programs and FCA LiabilityThird Circuit Holds that Whistleblower Can Still Be Fired for MisconductAnti-Retaliation under the False Claims Act

Reverse False Claims

Fourth Circuit Holds that Violation of CIA Can Support Reverse False Claims and Adopts Relaxed Rule 9(b) Presentment RequirementSecond Circuit Addresses “Obligation” Requirement of False Claims Act’s Reverse False Claim ProvisionFalse Claims Act Fundamentals: Reverse False Claims

Rule 9(b)

Fourth Circuit Holds that Violation of CIA Can Support Reverse False Claims and Adopts Relaxed Rule 9(b) Presentment RequirementSupreme Court Review of Key FCA IssuesThird Time is Not the Charm – Supreme Court Denies Cert. on Rule 9(b) Split Again

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

New False Claims Act Settlement Highlights Importance of Voluntary Self-Disclosures and Due DiligenceInnovasis Settlement ImplicationsThe Tale of an AKS Self-Disclosure

Settlement

DOJ Settlement Highlights Customs, FCA Risks for ImportersSeoul Medical Group and Renaissance Imaging Medical Associates Settle Medicare Risk Adjustment Fraud Case for $62 MillionFalse Claims Act Enforcement in Healthcare: Insights from the 13th Annual Fraud & Abuse Review

Stark Law

Download Now – 13th Annual Healthcare Fraud & Abuse ReviewHHS-OIG Year in Review 2024Fraud and Abuse Chapter of Health Law Handbook, 2024-2025 Edition

State and Other Supreme Courts

FCA Deeper Dive: Escobar and Its Aftermath – Part I

State/Local FCA

Download Now – 13th Annual Healthcare Fraud & Abuse ReviewFalse Claims Act Application in Nevada Worker Classification Fight Against LyftDownload Now – 12th 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

FCA Statute of Limitations Triggered by Notice to DOJ Only, Court RulesFalse Claims Act Fundamentals: Statute of LimitationsSupreme Court Wrestles with “Terribly Drafted” FCA Statute of Limitations

Telehealth

Recent DOJ Indictment Involving Done Global Telehealth PrescriptionsFalse Claims Act Case Unsealed Against Cerebral, Showing Continued Scrutiny of Telehealth PrescriptionsTelehealth Scrutiny Following COVID-19 Pandemic

United States Supreme Court

Supreme Court Clarifies “Claim” Definition Under False Claims ActRegister Now: The Supreme Court and the False Claims Act Webinar ReplaySupreme Court Upholds Broad Government Authority to Dismiss Qui Tam False Claims Act Lawsuits

Whistleblower

Key Takeaways from DOJ’s Continued Cybersecurity EnforcementFalse Claims Act Gives Broad Dismissal Authority to Government, District Judge SaysFalse Claims Act Enforcement in Healthcare: Insights from the 13th Annual Fraud & Abuse Review

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