Federal District Court Opines on Revised Stark Law Writing Requirement

On March 15, 2017, the U.S. District Court for the Western District of Pennsylvania provided the first federal court interpretation of the writing requirements affecting several regulatory exceptions in the federal physician self-referral statute (“Stark Law”) and its implementing regulations since the Centers for Medicare & Medicaid Services (“CMS”) provided... Continue Reading →

Fourth Circuit Says Attorney General Holds “Unreviewable Veto Power” Over Qui Tam Settlements and Sends Statistical Sampling Issue Back to the Trial Court

0
The Attorney General of the United States has an unreviewable veto power over qui tam settlements, according to the Fourth Circuit’s recent published decision in United States ex rel. Michaels v. Agape Senior Community.[1] In the same decision, the court declined to decide an issue raised by the relators over... Continue Reading →

Tags: , , , , , , , , ,


Courts Return to Real Particularity to Meet Rule 9(b)’s “Fraud with Particularity” Requirement

0
The courts appear to be walking back their trend toward loosening False Claims Act (“FCA”) pleading requirements. The FCA is a fraud statute, and lawsuits alleging FCA violations must be pled under Rule 9(b) of the Federal Rules of Civil Procedure: Fraud or Mistake; Conditions of Mind. In alleging fraud or mistake,... Continue Reading →

Tags: , , , , , , , , ,


Statistical Evidence and the False Claims Act

0
The False Claims Act[1] is a fraud statute; therefore, False Claims Act complaints must be pled with particularity,[2] identifying “the who, what, when, where, and how of an actual false claim” submitted to the government.[3] Whistleblowers without evidence of specific claims have tried to circumvent the rule with statistics, showing... Continue Reading →

Tags: , , , , ,


Trial Court Pushes Back on “Fraud with Particularity” Requirement

0
The Federal District Court for the Middle District of Florida appears  to have rejected recent direction from the Eleventh Circuit Court of Appeal to deny a motion to dismiss in a False Claims Act case. In United States ex rel. Napoli et al. v. Premier Hospitalists PL, et al. the... Continue Reading →

Tags: , , , , , , , , ,


OIG Final Rule Significantly Expands Exclusion Authority

0
On January 12, 2017, the Department of Health and Human Services Office of Inspector General (“OIG”) published the “Health Care Programs: Fraud and Abuse; Revisions to the Office of Inspector General’s Exclusion Authorities” Final Rule (“Final Rule”) revising and expanding its authority to exclude individuals and entities from participation in... Continue Reading →

Tags: , , , , , , , , , , , , , , , , , , , ,


Escobar, Back at the First Circuit

0
Yesterday, the First Circuit Court of Appeals issued a new opinion in Universal Health Services, Inc. v. United States ex rel. Escobar.  Applying the materiality test enunciated by the Supreme Court in June, the First Circuit reaffirmed its previous decision that the whistleblowers’ complaint sufficiently stated a claim under the... Continue Reading →

Tags: , , ,


Skilled Nursing Facility Chain Settles False Claims Act Case for $145 Million

0
On October 24, the Department of Justice (“DOJ”) announced a $145 million False Claims Act settlement with a national skilled nursing facility provider that operates more than 200 skilled nursing facilities (the “Company”) and its individual owner. The settlement has been touted as the largest in the DOJ’s history with a skilled nursing facility... Continue Reading →

Tags: , , , ,


Seventh Circuit: Implied Certification Claims Remain a Heavy Lift

In light of the Supreme Court’s recent decision in Universal Health Services v. Escobar, the Seventh Circuit revisited its prior ruling in United States ex rel. Nelson v. Sanford-Brown, Ltd, a case alleging that a college receiving federal subsidies violated the False Claims Act (“FCA”) by maintaining discriminatory recruiting and... Continue Reading →

Tags: , , , ,


Court Strikes Allegations Whistleblower Learned Through Discovery and Dismisses Claims

0
In United States of America and the State of Florida, ex rel. Bingham v. HCA, Inc., the employee of a medical office building management firm filed suit against a national health care system in the U.S. District Court for the Southern District of Florida. The lawsuit included allegations relating to... Continue Reading →

Tags: , , ,