Legal Insights & Articles

Whistleblower Awarded More Than $2 Million By Commodity Futures Trading Commission

By Susan Schneider Thomas An individual whistleblower who provided information about fraud to the Commodity Futures Trading Commission (“CFTC”) was just awarded more than $2 million for information that led to both a CFTC action and a related action brought by another federal agency. The whistleblower’s contribution included significant assistance in analyzing complex market [...]

By | 2019-03-13T10:10:44+00:00 March 13th, 2019|Commodities Futures Trading Fraud|

What is Best Price Fraud?

By Susan Schneider Thomas “Best Price” is a term used in connection with Medicaid reimbursement for brand name prescription drugs. Essentially, a drug manufacturer is required to charge Medicaid no more than whatever its best (lowest) price is to a non-government (or commercial) payor. Because Medicaid does not buy drugs outright and furnish them [...]

By | 2019-03-11T13:01:52+00:00 March 11th, 2019|Healthcare Fraud|

What is Customs Fraud?

By Susan Schneider Thomas Customs fraud is a catch-all term for frauds committed by companies trying to evade payments that are owed to the federal government in connection with the importation of goods into the United States. While there are many variations, the two major types of payments that are in play for imported [...]

By | 2019-03-06T09:41:53+00:00 March 6th, 2019|Customs Fraud|

Objective Falsity Requirement Under the False Claims Act

By Russell Paul Can a False Claims Act case go forward where the only evidence of whether the services at issue were medically necessary are two competing and opposing medical opinions? In a prior blog, we discussed recent holdings in AseraCare I, AseraCare II and Vista Hospice[1].  The main issue addressed in those cases [...]

By | 2019-02-27T10:09:24+00:00 February 27th, 2019|Healthcare Fraud|

Differences in Medical Opinion Under the False Claims Act

By Russell Paul Courts have recently grappled with the issue of whether a Relator can maintain a case under the False Claims Act (“FCA”) where she retains an expert that says the medical services provided were not medically necessary and the defendant’s medical service provider or its retained expert says the exact opposite – [...]

By | 2019-02-25T13:23:10+00:00 February 25th, 2019|Healthcare Fraud|

Whistleblower Rewards: How They Work

By Jonathan DeSantis The federal False Claims Act (“FCA”) allows an individual with knowledge of fraud upon the federal government, often known as a whistleblower or qui tam relator, to bring a lawsuit on the federal government’s behalf to recover the funds. Many states  have adopted similar laws that apply to fraud upon state and [...]

By | 2019-02-22T09:43:50+00:00 February 22nd, 2019|False Claims Act Information|

What is a Qui Tam Relator?

By William Ellerbe The simplest answer is that, in False Claims Act (“FCA”) cases, the relator is the whistleblower who brings the FCA claims against the company or individual who is committing fraud. Usually a qui tam relator is an insider—typically a current or former employee—who has access to confidential information showing that his [...]

By | 2019-02-21T10:59:44+00:00 February 21st, 2019|False Claims Act Information|

Tennessee Whistleblower Law

By William Ellerbe The Tennessee False Claims Act  (“Tennessee FCA”) mirrors the federal False Claims Act (“FCA”), but it involves claims made to state and local governments in Tennessee, as opposed to the federal government. The Tennessee Medicaid False Claims Act (“Tennessee Medicaid FCA”) applies to any false claims made to Tennessee’s state Medicaid [...]

By | 2019-02-06T09:50:06+00:00 February 6th, 2019|False Claims Act Information|

What is Medicaid Fraud?

By Arthur Stock Medicaid pays for approximately 20% of all healthcare expenses in the United States, over $600 billion each year. Well over 500,000 healthcare providers, ranging from hospital chains to individual doctors to ambulance helicopter pilots, receive payments from Medicaid every year. Inevitably a few of the providers will try to defraud the [...]

By | 2019-02-04T10:55:30+00:00 February 4th, 2019|Medicaid Fraud|

What is Whistleblowing?

By Lane L. Vines The eighteenth-century philosopher, Edmund Burke, long ago cautioned that, “All that is necessary for the triumph of evil is that good people do nothing.” That admonition still holds true today.  Whistleblowing involves individuals willing to come forward to stop fraud and other wrongdoing against the government (and by extension, the [...]

By | 2019-01-31T14:33:16+00:00 January 31st, 2019|False Claims Act Information|
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