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 →Tags: Department of Defense, Department of Homeland Security, False Claims Act, FCA, implied certification, Kelly, Regulations, Serco, summary judgment
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 →Tags: Cephalon, Cestra, False Claims Act, FCA, first to file, jurisdiction, timing
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 →Tags: AKS, Anti-Kickback, Brown, False Claims Act, FCA, Fifth Circuit, Parikh, qualified immunity, Stark
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 →Tags: civil, criminal, Department of Justice, False Claims Act, qui tam
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 →Tags: False Claims Act, FCA, Fresenius, Keltner, Lakeshore Medical Clinic, qui tam, South Carolina, Toumey, ulysses, whistleblower
— 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 →Tags: False Claims Act, FCA, Keltner, Lakeshore, Milwaukee, overpayment, qui tam, retained, whistleblower, Wisconsin
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 →Tags: Anchor Mortgage, Carter, False Claims Act, fraud, Halliburton, KBR, Keltner, overpayment, particularity, reverse false claim
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 →Tags: 6th Circuit, condition of participation, condition of payment, Dalse C, express false certification, false certification, False Claims Act, FCA, implies certification, MedQuest, sixth Circuit, summary judgment
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 →Tags: CMS, denied, False Claims Act, inpatient, Medciare, outpatient, rebill, rule
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 →Tags: Dodd-Frank, False Claims Act, FCA, FERA, HHS, OIG, PPACA