Eleventh Circuit: “Worthless Services” Claim Constitutional in Criminal Fraud Case

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The Eleventh Circuit ruled last week that a conviction for criminal health care fraud against the owner of nursing home facilities was constitutional. The Court held that the government’s “worthless service” theory of fraudulent billing was not unconstitutional.... Continue Reading →

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Eighth Circuit: Regulatory Noncompliance Does Not Violate FCA

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The Eighth Circuit’s recent decision adds to a growing body of case law rejecting FCA relator allegations of regulatory noncompliance as the basis for FCA claims. It reinforces the position that when health care providers reasonably interpret complicated and confusing billing guidelines and regulations, they cannot violate the FCA.... Continue Reading →

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False Claims Act Update, May 2013

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Three new FCA cases of interest were reported in the last few weeks. One was discussed previously on FCADefense.com in Toumey Loses Stark/FCA Case Again by Drew Howk. Another, Ulysses, Inc. v. United States 1 is yet another example of the growing trend of failed FCA counter-claims by the Government in response... Continue Reading →

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Retained Overpayments Change the FCA Ball Game

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— False Claims Act defense attorneys have been warning government contractors, particularly Medicare and Medicaid providers, of increased risks and a reduced ability to defend against whistleblower complaints since the passage of the Fraud Enforcement Recovery Act of 2009 (“FERA”). The greatest risk comes from FERA’s addition of a new... Continue Reading →

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April False Claims Act Update

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Introduction Three cases are addressed in a review of the False Claims Act decisions of the past month. The first, US v. Anchor Mortage Corp., is a significant Seventh Circuit case addressing the proper treble damages calculation under the statute. The second, US ex rel. Carter v. Halliburton, considers the application... Continue Reading →

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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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