7th Circuit Rules “Usual and Customary Pricing” Can Include Discount Programs

Posted on May 31, 2016 in Case Analysis, Materiality, Pharmacy

A recent whistleblower case could have a significant impact on Medicare Part D charge limits and corresponding reimbursement and could have ripple effects for aspects of other Medicare programs. The Seventh Circuit Court of Appeals ruled that reduced prescription prices offered by a large retail pharmacy (here Kmart) to participants enrolled... Continue Reading →

Tags: False Claims Act, FCA, Garbe, Kmart, pricing, usual and customary

Enforceability of FCA Releases Questioned

Posted on May 30, 2016 in Case Analysis, Employment, Release

Releases of FCA claims my only be effective in very limited circumstances, the Second Circuit Court of Appeals ruled in a decision this week. In US ex rel. Ladas v. Exelis, Inc, et al., the court ruled that a pre-filing release is unenforceable as a matter of public policy –... Continue Reading →

Tags: Exelis, False Claims Act, FCA, Lados, Release, Second Circuit, settlement

Massive Spike in FCA Penalties

Posted on May 4, 2016 in Damages, Retained Overpayments, Settlement, Statutes and Regulations

In November 2015, the Bipartisan Budget Act of 2015 went into effect. One aspect of that act was the Federal Civil Penalties Inflation Adjustment Act Improvements Act of 2015. The new law required that the Program Fraud Civil Remedies Act and the False Claims Act (“FCA”) penalties be “corrected” to adjust... Continue Reading →

Tags: BIpartisan Budget Act, Civil Monetary Penalty, False Claims Act, penalties, Railroad Medicare, Railroad Retirement Board, regulation

Government Approval and Percentage in FCA Cases

Posted on April 6, 2016 in Case Analysis, Settlement

An Indiana Federal District Court just published an opinion on an issue of first impression in the Seventh Circuit, the ability of the government to reject or approve a settlement in a case in which they did not intervene. The court also opined on the ability of a whistleblower to... Continue Reading →

Tags: False Claims Act, FCA, Howze, settlement, Sleep Centers, whistleblower

Sixth Circuit Rejects HITECH FCA Complaint

Posted on March 14, 2016 in False Certification, Regulatory Noncompliance

The Sixth Circuit Court of Appeals, in US ex rel. Sheldon v. Kettering Health Network, affirmed the dismissal of a False Claims Act (“FCA”) suit alleging fraud based upon certifications of compliance with the HITECH Act and a data breach. The HITECH Act, or Health Information Technology for Economic and Clinical... Continue Reading →

Tags: 6th Circuit, certification, False Claims Act, FCA, HITECH Act, Kettering Health Network

Fourth Circuit Addresses Expanded Definition of “Original Source”

Posted on February 17, 2016 in Case Analysis, Legal Updates, Litigation Handbook, Original Source, Public Disclosure Bar

In 2010, the False Claims Act (“FCA”) was extensively amended to limit the public disclosure bar and to expand the ability of whistleblowers to qualify as “original sources” in qui tam litigation. This month, the Fourth Circuit Court of Appeals took an in-depth look at both provisions, in the case US ex... Continue Reading →

Tags: False Claims Act, FCA, original source, public disclosure, Third Circuit

60-Day Overpayment Rule Released

Posted on February 11, 2016 in Legal Updates, Retained Overpayments, Reverse False Claims, Statutes and Regulations

CMS has released its final 60-Day Overpayment Rule, providing clarity to the 2010 Affordable Care Act (“ACA”) amendment to the False Claims Act (“FCA”) that created FCA liability for failure to repay identified overpayment within 60 days. This is a long-awaited rule that provides essential clarity to an amendment that,... Continue Reading →

Tags: CMS, False Claims, False Claims Act, FCA, Retained Overpayments, rule

“I refute it thus.” The FCA and “Valueless” Damages Claims

Posted on February 10, 2016 in Damages, False Certification, Statutes and Regulations, Worthless Services

Some court decisions are so marvelous, so great at cutting through all the legal argument and theoretical absurdity, that they deserve to be quoted at length. On February 4, 2016, the Hon. Raymond M. Kethledge of the Sixth Circuit Court of Appeals wrote just such an opinion. What follows is the first... Continue Reading →

Tags: actual damages, Damages, Davis-Bacon Act, False Claims Act, FCA, valueless

Katherine A. Kuchan, R.N., J.D.

Posted on October 28, 2015 in Biographies

Katherine A. Kuchan, R.N. Hall, Render, Killian, Heath & Lyman, P.C. 111 East Kilbourn Avenue Suite 1300 Milwaukee, WI 53202 Phone: (414) 721-0479 Fax: (414) 721-0491 Email: kkuchan@hallrender.com vCard: Download vCard Biography Katherine Kuchan, a nurse and Shareholder in the firm, provides legal counsel to hospital systems, individual hospitals, inpatient rehabilitation facilities,... Continue Reading →

Tags: False Claims Act, FCA, JD, Kuchan, RN

J. Patrick Garcia

Posted on October 25, 2015 in Biographies

Hall, Render, Killian, Heath & Lyman, P.C. 180 Admiral Cochrane Drive Suite 370 Annapolis, MD 21404 Phone: (443) 951-7043 Email: pgarcia@hallrender.com vCard: Download vCard Biography Patrick Garcia regularly advises clients on regulatory and compliance issues with a particular focus on fraud and abuse laws, including Anti-Kickback, Stark, and False Claims... Continue Reading →

Tags: False Claims Act, FCA, J. Patrick Garcia, Patrick Garcia