DOJ Seeks to Nearly Double Health Care Fraud Litigation Budget for 2016

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Just three months ago, the Department of Justice announced a record year for False Claims Act recoveries totaling more than $5 billion – including $2.3 billion from health care defendants alone. Helping contribute to these recoveries was another record: over 700 whistleblower cases filed in 2014. Yesterday, as part of... Continue Reading →

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Materiality and Government Knowledge in the Sixth Circuit

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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 →

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Seventh Circuit: “Information and Belief” Insufficient under 9(b)

In U.S. ex rel. Grenadyor v. Ukranian Village Pharmacy, Inc. et al., the Seventh Circuit affirmed a trial court’s dismissal  of a whistleblower’s complaint for its failure to provide sufficient specificity regarding the alleged fraud. In the opinion, Judge Posner drives a stake through the heart of a common boilerplate phrase  with clarity and... Continue Reading →

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Eastern District of Tennessee Denies Interlocutory Appeal of Order Permitting Sampling to Prove Liability

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In September, the District Court for the Eastern District of Tennessee issued an order denying Defendants’ motions for summary judgment and permitting the government to use statistical sampling to determine liability in a False Claims Act case. The decision – a first in FCA jurisprudence – was immediately the subject of a motion... Continue Reading →

DOJ Announces that 2014 Sees Record FCA Recoveries and Whistleblower Lawsuits

Yesterday, November 20, the Department of Justice (“DOJ”) announced that the United States had recovered almost $6 billion from False Claims Act (“FCA”) litigation in 2014 – marking the first time the DOJ has recovered more than $5 billion in a single year. With these recoveries, the DOJ reached several milestones. Not... Continue Reading →

Seventh Circuit Rejects Novel Fraud Theory

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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 →

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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 →

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False Claims Act Update – Public Disclosure and Original Source

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Several FCA opinions have been issued since the last FCA Update. The most interesting is a District of Nevada case, US ex rel Guardiola v Renown Health. Renown Health was the parent company for two other corporate defendants that provided acute health care services. The relator was Renown’s Director of Clinical Compliance. She... Continue Reading →

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Safe Harbors Less Safe in Ohio

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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 →

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