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
Effective training prepares contractors and providers to recognize more than kickbacks. The example below reveals that not all kickback violations are intuitively obvious. What seems a clear violation to those familiar with anti-kickback and false claims statutes, may seem just a straightforward business arrangement to someone unfamiliar with them. After all, what is wrong when providers … Continue Reading
June 16, 2017, marks the one-year anniversary of the precedent-setting U.S. Supreme Court decision in Universal Health Services v. United States ex rel. Escobar (Escobar), which approved the implied false certification theory as a basis for liability under the False Claims Act (FCA). Because the decision impacts every provider who supplies goods and services to … Continue Reading
