08/15/2013 - Houston Business Journal Guest Article: Are You Afraid of the False Claims Act? You Should Be
The False Claims Act (FCA) is a federal statute traditionally used to prosecute government contractors and health care providers for defrauding the government.
07/11/2013 - Texas Passes New Laws Designed to Crack Down on Medicaid Fraud
Governor Perry recently signed four bills into law designed to combat Medicaid fraud, waste, and abuse. The bills are a mixed bag of enhanced enforcement capabilities for the state and a few new protections for healthcare providers.
06/10/2013 - First Circuit Holds Rule 9(b) Does Not Apply to the FCA’s First-To-File Rule
The First Circuit recently held that complaints filed first under the False Claims Act’s first-to-file rule do not need to satisfy Federal Rule of Civil Procedure 9(b)’s particularity requirement.
04/19/2013 - OIG Releases Updated Self-Disclosure Protocol
On April 17, 2013, the Health and Human Services Office of Inspector General (OIG) released an Updated Provider Self-Disclosure Protocol (SDP), which replaces the original SDP published in 1998.
03/27/2013 - Seventh Circuit Clarifies How to Treble Damages under the FCA
The Seventh Circuit recently reversed a $2.7 million damages award against a mortgage company accused of lying in applications for federal loan guarantees. See United States v. Anchor Mortg. Corp.
, 2013 WL 1150213 (7th Cir. Mar. 21, 2013).
03/04/2013 - Jury Awards $28 Million in False Claims Act Suit against Nursing Home
A federal court jury in Illinois found that nursing home operator Momence Meadows fraudulently billed Medicare and Medicaid for “worthless services” and falsely certified compliance with health care laws and regulations, resulting in $28 million in damages to the government.
12/05/2012 - Federal Judge Orders Disclosure of Emails with In-House Counsel in FCA Case
In light of a recent federal court order, companies – especially those at risk of False Claims Act suits – should revisit their protocol for handling communications with in-house counsel.
08/15/2012 - Fifth Circuit Holds SEC Claims Against Bartek Untimely
In Securities and Exchange Commission v. Bartek
, the Fifth Circuit held that the federal “catch all” statute of limitations for government enforcement actions - 28 U.S.C. § 2462 - begins to run when the violation occurs, not when the government discovered the violation.
04/05/2012 - Appeals Court Overturns $44 Million Judgment Against Tuomey Hospital in Important Stark Law Case
The U.S. Fourth Circuit Court of Appeals has reversed a $44 million judgment against Tuomey Hospital in Sumter, South Carolina that arose from Tuomey’s employment arrangements with physicians that allegedly violated the federal Stark Law.
04/03/2012 - Fate of Health Reform is Uncertain after Supreme Court Oral Arguments
After three days of historic oral arguments before the U.S. Supreme Court, the fate of the Affordable Care Act (ACA), the momentous 2010 health reform law, is uncertain, given robust questioning of the ability of Congress to force individuals to purchase health insurance.
03/15/2012 - American Health Lawyers Association's Connections Magazine: Successor Liability in Healthcare Transactions
With the passage of the Affordable Care Act (ACA) in March 2010, Congress made the most significant change in the U.S. healthcare delivery system since the inception of the Medicare program.
02/20/2012 - CMS Proposes Rules on Reporting and Returning Overpayments: Providers May Have Duty to Make Reasonable Inquiry With Deliberate Speed
The Centers for Medicare and Medicaid Services (CMS) on February 16, 2012 proposed rules implementing Section 6402(a) of the Affordable Care Act, requiring persons to report and return Medicare overpayments by the later of 60 days after an overpayment is identified or the date any corresponding cost report is due.
11/09/2011 - D.C. Circuit Dismisses Sallie Mae FCA Suit Based on First-to-File Rule
The United States Court of Appeals for the D.C. Circuit recently held that a complaint does not need to meet the heightened pleading standards for fraud claims in order to satisfy the first-to-file rule under the False Claims Act (“FCA”).
08/30/2011 - Florida Fines Medicaid HMO for Failing to Report Suspected Fraud by Providers
The Florida Agency for Health Care Administration (“AHCA”) earlier this month fined Humana $3.4 million for failing to promptly report suspected cases of Medicaid fraud and abuse by others, as required by statute and Humana’s Medicaid HMO contract. Though many states have similar laws or regulations, this appears to be the first enforcement action of its kind in the nation.