N.D. Ill.: Upcoding Allegations Against Hospitalist Group Survive Motion to Dismiss

0
A recent case out of the Northern District of Illinois Federal Court, US ex rel. Oughatiyan v. IPC the Hospitalist Company, Inc., demonstrates the high risk inherent in evaluation and management (E&M) coding for health care providers.... Continue Reading →

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


Boilerplate Litigation and the False Claims Act

0
Written by David B. Honig and Delphine P. O’Rourke Assertion of affirmative defenses creates risk for clients, attorneys and law firms.  Treating False Claims Act litigation like any other litigation will lead to the unnecessary expenditure of time and money and potentially sanctions. A recent decision out of the Southern District of Texas, United States ex rel. King v Solvay... Continue Reading →

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


Up the Creek Without a Regulation

by David B. Honig and Brian C. Betner CMS Announces Further Delay of Repayment Rule To be published in the February 17, 2015 Federal Register, CMS has extended its deadline for finalizing the Affordable Care Act’s (“ACA”) 60-day payback rule. This is the rule that requires a Medicare or Medicaid provider to return... Continue Reading →

Tags: , , , ,


Self-Disclosure, the Public Disclosure Bar and the FCA – Uncertainty, Circuit by Circuit

Written by David B. Honig and Ritu Kaur Cooper. On February 3, 2015, the Fourth Circuit Court of Appeals ruled that disclosures to the public officials responsible for managing the subject of a False Claims Act lawsuit did not qualify as “public disclosures” for the purpose of the FCA’s public disclosure bar. US... Continue Reading →

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


Court Awards Prevailing FCA Defendant Costs

with Drew B. Howk On Monday, February 2, well-respected Federal District Court Judge Jed S. Rakoff awarded costs to the prevailing Defendant in US ex rel. Associates Against Outlier Fraud v. Huron Consulting, Case No. 09 Civ. 1800(JSR). The case had a long history. The Complaint was originally filed in February 2009. It... Continue Reading →

Tags: , , , , , ,


Materiality and Government Knowledge in the Sixth Circuit

0
Written by David B. Honig and Steven H. Pratt. On February 2, the Sixth Circuit Court of Appeals ruled on a case from the Southern District of Ohio, US ex rel American Systems Consulting, Inc. v Mantech Advanced Systems International. At issue was whether a court may determine whether a knowingly false... Continue Reading →

Tags: , , , , , , , , ,


Seventh Circuit Rejects Novel Fraud Theory

0
Relator Thulin was a pharmacist in Idaho working for Shopko, a Wisconsin company. He filed an FCA claim alleging Shopko defrauded Medicaid by failing to pass along private insurance plan prices to Medicaid for dual-eligible patients. The court rejected Shopko’s claim, affirming the trial court’s grant of a motion to... Continue Reading →

Tags: , , , , , ,


New 11th Circuit Case: Fraud with Particularity

Last week, the 11th Circuit Court of Appeals issued its unpublished ruling in US ex rel. Mastej v. Health Management Associates, Inc. At issue was whether the relator’s Third Amended Complaint adequately pled fraud with particularity, as required by Fed.R.Civ.Pro. 9(b). Mastej was an Health Management Associate (“HMA”) executive from 2001 to... Continue Reading →

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


Safe Harbors Less Safe in Ohio

0
In a new case from the Southern District of Ohio, US_v_MillenniumRadiology, the court denied a motion to dismiss a False Claims Act suit, finding that compliance with a safe harbor could only be raised on summary judgment. The court also found that uncompensated service as a medical director could form the basis... Continue Reading →

Tags: , , , , , , ,


Last Week in the FCA

From October 1 through October 12, 2014, there were 14 federal cases reported that mentioned the False Claims Act. One was previously discussed in the September 2014 FCA Update. Eight more only tangentially discussed the False Claims Act. Five cases might be of interest to parties and counsel in a False... Continue Reading →

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