Sixth Circuit: Violations of Conditions of Participation Insufficient Basis for FCA Claims

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By David B. Honig and Andrew B. Howk In U.S. v. MedQuest, the Sixth Circuit held that violations by a provider of conditions of participation in Medicare were insufficient as a matter of law to “trigger the hefty fines and penalties created by the FCA.” This case was a reaffirmation... Continue Reading →

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CMS Publishes Administrative Ruling and Proposed Rule Providing Additional Part B Payment to Hospitals Denied Inpatient Payment

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Executive Summary On March 13, 2013, CMS concurrently released an immediately effective administrative ruling (“CMS Ruling 1455-R” or “Ruling”) and a proposed rule (“Proposed Rule”) reversing CMS policy precluding hospitals from billing on an outpatient basis for inpatient services denied payment on grounds the services should have been provided on... Continue Reading →

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OIG Issues New Guidelines for Review of State FCA Statutes

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The recent amendments to the False Claims Act, the Fraud Enforcement Recovery Act of 2009 (“FERA”), the Patient Protection and Affordable Care Act of 2010 (“PPACA”) and the Dodd-Frank Wall Street Reform and Consumer Protection Act (“Dodd-Frank”) continue to generate new rules and guidance. Effective 2007, Congress created incentives for states to pass... Continue Reading →

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False Claims Act Update

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Appellate Court Cases Three appellate-level FCA cases were reported in January and February 2013. Only one, U.S. ex rel. Nathan v. Takeda Pharmaceuticals North America, Inc., 1 was selected for publication. All three cases addressed Rule 9(b)’s requirement that allegations of fraud be lead “with particularity.” The cases, read together,... Continue Reading →

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Here Be Dragons – Regulatory Law and the Advice-of-Counsel Defense

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  by David B. Honig Federal regulations are an enormous morass of complex, confusing, and often contradictory rules. The 2009 Code of Federal Regulations was 163,333 pages in 226 individual books.  The 2010 Federal Register, which contains new regulations proposed rules, and presidential papers, contained an additional 81,305 pages.  Intended... Continue Reading →

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FCA – ACA = ?

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This Thursday, June 28, 2012, the United States Supreme Court will decide the fate of the Patient Protection and Affordable Care Act, aka “Obamacare.” In so doing, it may also make significant changes in one of the newest and most complicated amendments the False Claims Act, with results that are... Continue Reading →

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U.S. ex rel. Clausen v. Laboratory Corp. of America, Inc.

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290 F.3d 1301, (11th Cir. 2002). To adequately plead a False Claims Act case under Fed.R.Civ.P. 9(b), a whistleblower may not merely plead a scheme to defraud. Rather, they whistleblower must plead and identify actual claims which are false. For more information, please contact David B. Honig at dhonig@hallrender.com or... Continue Reading →

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Do whistleblowers have to plead with particularity for every claim?

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Pleading a False Claims Act case can be a tricky exercise, and in defending an FCA case, it is important to know just what the rules are for a whistleblower, and how they can fail to meet them. One of the most common mistakes made by whistleblowers is failing to “plead fraud... Continue Reading →

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