The False Claims Act (FCA), 31 U.S.C. 3729, et seq., is about to become the worst-kept secret of the healthcare industry. One of the nation's oldest statutes, the FCA has allowed the government to recover more than $3.1 billion in the first nine months of 2006, including an eye...
2023 proved that there is never a dull moment when it comes to the False Claims Act (FCA). It was an especially significant year in terms of enforcement developments. The Department of Justice (DOJ) recovered approximately $2.7 billion through FCA settlements and judgments, making FY 2023 the...
Supreme Court held that that “[t]he False Claims Act’s scienter element refers to the pharmacies’ knowledge and subjective beliefs (not to what an objectively reasonable person may have known or believed).1,2 The Supreme Court further opined that the basis for determining the parties’ “...
NextGen Healthcare has arrived at a$31 million settlementwith the Department of Justice (DOJ) to resolve allegations that it overstated its EHR capabilities to gain government certification, a violation of the False Claims Act. A lengthy investigation revealed that the EHR vendor explo...
Martin v. Hathaway, holding that plaintiffs in False Claims Act (FCA) cases alleging a violation of the Anti-Kickback Statute (AKS) must establish that the false claim would not have occurred "but for" the illegal kickbacks. Circuit decisions have been split regarding what kind of causal ...
Molina Healthcare has reached a $4.6 million settlement to resolve allegations that it violated the False Claims Act after submitting improper claims for Medicaid reimbursement.
The False Claims Act enables a private citizen with unique knowledge of fraud committed against the federal government (such as health care fraud, contract fraud, and tax fraud) to file a lawsuit under seal (not accessible to the public) seeking treble (triple the amount) damages on behalf ...
Health care providers have always been worried about liability under the False Claims Act (FCA). The FCA is a civil liability statute imposing stiff penalties for knowingly submitting false bills to federal government payors, including bills for health care services submit...
In 2018, the False Claims Act (“FCA”) continued to be one of the federal government’s (“Government”) preferred civil fraud enforcement tools across a variety of industries. The healthcare industry, however, remained the epicenter of FCA enforcement. Whistleblowers (“relators”), too, ...
Frivolous ClaimsGate-Keeping FunctionMoral HazardThis short piece discusses recent (internal) Justice Department guidance for attorneys handling False Claims (FCA) Act cases. In a dramatic policy and practice shift, the memorandum recommends that "when evaluating a recommendation to decline intervention ...