Utah has enacted a False Claims Act (“Utah FCA”), Utah Code Annotated sections 26–20–9.5 et seq.). The Utah FCA prohibits parties from “enter[ing] into an agreement, combination, or conspiracy to defraud the state by obtaining or aiding another to obtain the payment or allowance of a false, fictitious, or fraudulent claim for a medical benefit.” Utah Code [...]
Cost report fraud occurs when nursing homes, hospitals, and other healthcare providers for patient care falsely submit claims to the government for reimbursement. Medicare Part A healthcare providers that are paid under the fee-for-service based system can abuse federal government funding by: Inflating their patient care costs; Seeking reimbursement from the government for costs [...]
Medicare fraud broadly refers to any individual, company or corporation who acts intentionally to steal money from the federal government. “Phantom billing” is a specific kind of Medicare fraud, as well as the most common. Phantom billing occurs when healthcare providers submit claims for reimbursement to the government for services or procedures they did [...]
Under the False Claims Act (“FCA”), an organizational relator is a person with knowledge - typically a current or former employee - of a company involved in defrauding the federal government. The FCA incentivizes relators to come forward and report fraudulent activity by enabling the relator to claim a portion of the recovery if [...]
What is the CFTC? The U.S. Commodity Futures Trading Commission (“CFTC”) is an independent government agency that regulates US futures and options markets. The CFTC’s Division of Enforcement investigates violations of the Commodity Exchange Act (“CEA”) and other CFTC regulations, including fraud, market manipulation, disruptive trading practices, and trade practice violations. The Division of [...]
Congress passed the Sarbanes-Oxley Act of 2002 (also known as “SOX” and the Corporate Responsibility Act of 2002) in response to high-profile financial scandals in the early 2000s involving publicly traded companies such as Tyco, WorldCom and Enron, which called into question the trustworthiness of corporate financial statements. Its goal is to help protect investors from [...]
As readers of this blog well know, the False Claims Act allows individuals who become aware of fraud committed against the federal government to bring a lawsuit on the government’s behalf. Although there are a variety of restrictions, the whistleblower (also called a relator) files the case under seal, allowing the government to decide [...]
In an April 2019 opinion from the Eastern District of Pennsylvania, the court denied a company’s motion to require its employee to return all documents the employee had taken for purposes of reporting a suspected fraud to the government. In United States ex rel. Behnke v. CVS Caremark Corp., No. 14-cv-824, the court addressed [...]
On March 25, 2019, the Department of Justice announced a large settlement with Duke University for False Claims Act (“FCA”) allegations related to fraud in connection with federal grants. Duke will pay the government $112.5 million to resolve allegations that it violated the FCA through the submission of various applications and progress reports based [...]
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 data. Two takeaways from [...]
