“If you put something at risk (such as cash, entry fee, dinner or other tangible item) on any amateur and/or professional sporting event with a chance to win something in return, you violate NCAA sports wagering rules.”[1] Once the Supreme Court ruled unconstitutional the federal law[2] prohibiting sports betting in Murphy v. Nat’l Collegiate Athletic … Continue Reading
The Supreme Court recently heard oral argument in the appeal of two False Claims Act (FCA) cases from the Seventh Circuit that called into question the level of intent, or scienter, required to establish corporate liability under the FCA for “knowingly” overbilling the government for goods or services. The Court’s eventual decision may have widespread … Continue Reading
Expert testimony can play a crucial role in the trial process. Consequently, parties often file motions to disqualify the opposing side’s expert witnesses. The success of these motions in federal cases is controlled by the Federal Rules of Evidence (“FRE”), which stipulate that expert testimony must meet certain standards of reliability to be admissible. In … Continue Reading
Last week, the Sixth Circuit issued an important decision limiting the scope of claims alleging violations of the Anti-Kickback Statute that are brought under the False Claims Act. See Shannon Martin, M.D., et al. v. Hathaway, et al., No. 22-1463 (March 28, 2023). Chief Judge Sutton wrote the opinion for the Court, which Judge Siler … Continue Reading
We previously offered insight into two False Claims Act (“FCA”) enforcement actions brought by the U.S. Department of Justice (“DOJ”) as part of its “Civil Cyber-Fraud Initiative” (“CCF Initiative”). Deputy Attorney General Lisa O. Monaco announced the CCF Initiative in October 2021, stating that “[t]he initiative will hold accountable entities or individuals that put U.S. … Continue Reading
The U.S. Department of Justice announced late last year that it would utilize the False Claims Act, the U.S. government’s primary civil tool to redress false claims for federal funds and property, to bring actions against U.S. government contractors and subcontractors who do not meet the cybersecurity requirements of a particular contract or grant. The … Continue Reading
The United States Court of Appeals for the Sixth Circuit recently issued a published opinion regarding entitlement to attorney fees in a False Claims Act settlement that involved multiple relators, each of whom had filed a case in which the government intervened. Addressing arguments based on 31 U.S.C. s. 3730(d)(1), the first-to-file rule, and the … Continue Reading
The Department of Justice (“DOJ”) recently announced its largest ever health care fraud and opioid enforcement action. In a coordinated effort, DOJ charged 345 defendants with more than $6 billion in fraud losses for submitting false and fraudulent claims to federal health care programs and private insurers.… Continue Reading
Joseph “Jody” Hunt, Assistant Attorney General for the Civil Division, provided a glimpse of current civil enforcement priorities of the Department of Justice (DOJ). Speaking at the Federal Bar Association’s annual Qui Tam Conference on February 27, 2020, Hunt pledged that DOJ would pursue qui tam cases involving nursing homes, Medicare Advantage plans, and electronic … Continue Reading
The U.S. government relies upon whistleblowers to drive its recoveries under the False Claims Act. See our analysis here of how the Act’s qui tam provisions work, especially in healthcare, by Colin Jennings, Marisa Darden, and Ayako Hobbs.… Continue Reading
After a dip in the 2018 fiscal year, False Claims Act (FCA) settlements and judgments are back and climbing. The Department of Justice (DOJ) recently announced that it had obtained more than $3.05 billion from FCA settlements and judgments for the 2019 fiscal year. 2018 may have just been an aberration after the 2010s saw … Continue Reading
A post on our Triage blog discusses a decision about the legality of changing medical billing codes in order to maximize revenue from the government. Can that be done consistent with the False Claims Act? See the discussion here.… Continue Reading
The Department of Justice (DOJ) recently intervened in a False Claims Act (FCA) lawsuit involving allegations of kickbacks for prescription drug copays. The DOJ says the lawsuit makes “clear that the Department will hold accountable drug companies that pay illegal kickbacks to facilitate increased drug prices.” The DOJ “will not allow drug companies to use … Continue Reading
On May 31, 2019, the U.S. Attorney for the District of Kansas announced a $250,000 settlement with Coffey Health System, after two whistleblowers filed qui tam suit against Coffey for violations of the False Claims Act. The settlement resolved allegations that Coffey submitted false claims to Medicare and Medicaid pursuant to the Electronic Health Records … Continue Reading
This week, the Civil Division of the U.S. Department of Justice released guidelines on cooperation credit in False Claims Act cases. The guidelines strongly emphasize voluntary disclosure, but also provide insight into other actions that could give rise to cooperation credit.… Continue Reading
In 2018, the US Department of Justice (DOJ) issued many important policy updates and rollouts that will have far-reaching impact. Our firm’s Alert provides an easily navigated yet detailed summary of developments. Policy Shifts at the Department of Justice – 2018 in Review focuses on government investigations and white collar prosecutions. The Alert covers:… Continue Reading
The federal government’s recoveries for false claims during FY2018 topped $2.8 billion. The Department of Justice (DOJ) recently released this and other statistics for its civil False Claims Act recoveries since 1986. Although the most numerous and lucrative recoveries occurred in the health care industry, the DOJ reported 35 new qui tam cases involving the Department … Continue Reading
Third Circuit Clarifies Public Disclosure Bar in False Claims Act In United States v. Omnicare, Inc., the Third Circuit clarified the operation of the public disclosure bar in the False Claims Act (FCA). The court held that publicly available information “could not have reasonably or plausibly supported an inference” of fraud. This information included government … Continue Reading
Buried on page 2,201 of the 2,232-page 2018 Omnibus Spending Bill, the CLOUD Act was signed into law on March 23, 2018. The bill allows U.S. law enforcement to obtain U.S. citizens’ private data from servers anywhere in the world, provided that an agreement exists with that country on data sharing. However, the CLOUD Act … Continue Reading
The 2017 Year in Review of the Department of Justice reveals a Data Analytics Team (the “Team”) for tracking healthcare fraud. The Healthcare Fraud Unit launched the Team in order to provide data mining expertise that efficiently detects healthcare fraud. This development demonstrates that data analytics is the future of enforcement. A fuller description of the Team … Continue Reading
A recent blog post summarized an opinion in which a district court catalogued his reasons for rejecting a corporate “C” plea involving a pharmaceutical company. Several developments have occurred since the court’s opinion including a plea and sentencing hearing scheduled for January 30, 2018. … Continue Reading
The Department of Justice (DOJ) recently announced a False Claims Act (FCA) settlement with Kmart Corporation for $32.3 million. The settlement is part of a global $59 million settlement; the relator will receive $9.3 million. Former Kmart Employee Filed the Qui Tam James Garbe, the relator, was employed by Kmart as a pharmacist from 2007 until … Continue Reading
Government fraud settlements are getting more personal. Which means the Yates memorandum is having its intended effect. Issued in 2015, the memo requires that government attorneys focus more on individual liability when resolving fraud investigations. For example, that year only 6 settlements imposed personal liability on physicians settling complaints filed under the False Claims Act. According to … Continue Reading
Contractors and providers may face false claims damages when they fail to return overpayments even though no fraud is involved. A recent civil settlement demonstrates that the government is targeting failure to repay, and it can be as costly as fraudulent billing.… Continue Reading
