Legal Insights & Articles

Objective Falsity Requirement Under the False Claims Act

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 was whether a [...]

By |2020-08-24T12:03:35-04:00February 27th, 2019|Healthcare Fraud|

Differences in Medical Opinion Under the False Claims Act

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 – that the service [...]

By |2020-08-24T12:05:00-04:00February 25th, 2019|Healthcare Fraud|

Whistleblower Rewards: How They Work

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 local government entities. [...]

By |2020-08-24T12:05:31-04:00February 22nd, 2019|False Claims Act Information|

What is a Qui Tam Relator?

In False Claims Act (“FCA”) cases, the qui tam 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 or her employer has been committing [...]

By |2020-08-25T13:18:58-04:00February 21st, 2019|False Claims Act Information|

Tennessee Whistleblower Law

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 program. The Tennessee [...]

By |2020-08-24T12:06:29-04:00February 6th, 2019|False Claims Act Information|

Medicaid Fraud

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 program to line [...]

By |2020-08-24T12:07:04-04:00February 4th, 2019|Medicaid Fraud|

What is Whistleblowing?

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 taxpayers). Those individuals who [...]

By |2020-08-24T12:07:36-04:00January 31st, 2019|False Claims Act Information|

What is a Kickback Scheme?

Quite simply, a kickback is an inducement – offering or giving something of value in exchange for getting business referrals. Although that type of behavior can be perfectly legal in some segments of the commercial world, it is not permitted when the business that is being referred is paid for by government healthcare programs. [...]

By |2020-08-24T12:08:09-04:00January 25th, 2019|Healthcare Fraud|

Vermont False Claims Act

In 2015, Vermont enacted its own version of the federal False Claims Act.[1] Generally speaking, the Vermont False Claims Act is very similar to the Federal False Claims Act except that the Vermont law prohibits fraud upon the state government, while the federal law prohibits fraud upon the federal government. What the Vermont False [...]

By |2020-08-24T12:08:41-04:00January 8th, 2019|False Claims Act Information|

What are Medically Unnecessary Services?

Medical necessity has implications for good, safe patient care and for reimbursement or payment decisions. Although an unnecessary treatment is not always dangerous, it could be used in place of a more appropriate treatment. It could also have side effects or risks that are not justified when the treatment is not necessary in the [...]

By |2020-08-24T12:09:15-04:00December 17th, 2018|Healthcare Fraud|
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