September 2014 FCA Update

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

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

Qui Tam Complaints to Be Reviewed by Criminal Division

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

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

False Claims Act Update, May 2013

Posted on May 15, 2013 in Legal Updates

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

Retained Overpayments Change the FCA Ball Game

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

— 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

April False Claims Act Update

Posted on April 15, 2013 in Legal Updates

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

Sixth Circuit: Violations of Conditions of Participation Insufficient Basis for FCA Claims

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

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

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

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

OIG Issues New Guidelines for Review of State FCA Statutes

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

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

False Claims Act Update

Posted on February 27, 2013 in Case Analysis, Legal Updates

Appellate Court Cases Three appellate-level FCA cases were reported in January and February 2013. Only one, U.S. ex rel. Nathan v. Takeda Pharmaceuticals North America, Inc., 1 was selected for publication. All three cases addressed Rule 9(b)’s requirement that allegations of fraud be lead “with particularity.” The cases, read together,... Continue Reading →

Tags: Abbott, Bender, Conn, Conrad, Deck, False Claims Act, FCA, Griffith, Jajdelski, Kaplan, Miami Jacobs, Nathan, North American Communications, qui tam, relator, Takeda, whistleblower

The False Claims Act and Quality of Care

Posted on February 13, 2013 in Legal Updates

by David B. Honig Can the False Claims Act be used by the government or whistleblowers in quality of care cases? The Department of Justice seems to think so, based in significant part on the retention of overpayments amendments to the FCA by FERA and the PPACA. 1 If... Continue Reading →

Tags: False Claims Act, FERA, health, health care, hospital, liability, malpractice, overpayment, peer review, PPACA