Archives: Fraud

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CMS Proposes Invalidating Adjuster Methodology and Recouping Past Improper Payments From Medicare Advantage Organizations

On October 26, 2018, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that will, among other initiatives, allow CMS to recover higher dollar amounts of improper payments made to Medicare Advantage. To read more about this ruling and what it might mean for you, click here to read a recent Squire Patton … Continue Reading

Third Circuit Clarifies Public Disclosure Bar in False Claims Act

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

Serious Fraud Office: Apparent Renewed Faith

In the first part of this two-part post, we looked at some of the infamous cases that may explain repeated attempts by Theresa May, first as Home Secretary and later as Prime Minister, to dismantle the SFO, see here. Our attentions now turn to the important role the SFO continues to play in combatting corruption, … Continue Reading

Serious Fraud Office: Boost to Coffers Is Vote of Confidence

The UK’s Serious Fraud Office (“SFO”) recently received an unexpected, yet significant, increase in baseline funding for the 2018-2019 fiscal year. The funding boost comes in spite of Prime Minister Theresa May’s previous efforts, following several high-profile prosecutorial setbacks for the SFO, to fold it into the UK’s National Crime Agency (“NCA”). Relatedly, a new … Continue Reading

Government Fraud Settlements Are Getting More Personal

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
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