US ex rel. Kelly v. Serco, Inc.

Posted on October 14, 2014 in Case Cites

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US ex rel Kelly v Serco Case no. 11cv2975 /WQH-RBB (S.D.Cal. Oct. 6, 2014) Relator alleged the Defendant failed to follow government time and cost reporting requirements. The court found that Defendant impliedly certified compliance with certain regulations. However, the court found that the regulations, which applied to the Department... Continue Reading →

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US ex rel. Cestra v. Cephalon, Inc.

Posted on October 14, 2014 in Case Cites

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US ex rel Cestra v Cephalon Case No. 14-01842 (E.D.Penn. Oct. 9, 2014) In considering a first-to-file challenge to jurisdiction, the court compared the other relator’s complaint to the instant relator’s initial complaint, not his subsequently amended complaint, as the original complaint offers the facts at the time the second... Continue Reading →

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September 2014 FCA Update

Posted on October 12, 2014 in Case Analysis, Legal Updates

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Only one FCA case of interest was decided by a U.S. Circuit Court in September. In US ex rel Parikh v Brown, the Court found that a county hospital and its administrator’s participation in a “simple, brazen kickback scheme” could not be shielded by qualified immunity. The hospital and its administrator... Continue Reading →

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Qui Tam Complaints to Be Reviewed by Criminal Division

Posted on October 1, 2014 in Criminal Fraud, Government Intervention

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Leslie R. Caldwell, Assistant Attorney General for the Criminal Division, announced recently that all new qui tam complaints would be “shared by the Civil Division with the Criminal Division as soon as the cases are filed.” Fraud prosecutors will now review all qui tam complaints to determine whether to open a parallel criminal... Continue Reading →

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False Claims Act Update, May 2013

Posted on May 15, 2013 in Legal Updates

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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

Posted on May 5, 2013 in Case Analysis, Reverse False Claims

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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

Posted on April 15, 2013 in Legal Updates

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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

Posted on April 2, 2013 in Case Analysis, Conditions of Participation

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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

Posted on March 18, 2013 in Statutes and Regulations

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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

Posted on March 15, 2013 in Legal Updates, Statutes and Regulations

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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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