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July 10, 2017
False Claims Act Information
History and Purpose of the Public Disclosure Bar
Early Public Disclosure Bar In the early 1940s, some enterprising individuals filed False Claims Act (“FCA”) actions based not on their own independent knowledge of a fraud but on information revealed in criminal indictments. S.Rep. No. 99–345, at 10–11 (1986). This harmed the government because the FCA required the government […]
July 7, 2017
Healthcare Fraud
Bringing a False Claims Act Case Without Identifying Specific Claims to the Government
We wrote earlier about the important holding in one of this Firm’s cases, U.S. ex rel. Groat v. Boston Heart Diagnostics Corp., 2017 WL 2533341 (D.D.C. June 9, 2017), regarding the responsibility of a medical laboratory to ascertain whether lab tests ordered by physicians are medically necessary. That opinion also […]
July 5, 2017
False Claims Act Information
The False Claims Act’s Public Disclosure Bar Routinely Results in Windfalls to Fraudsters
In 1986, in an effort “to strike a balance between encouraging private persons to root out fraud and stifling parasitic lawsuits,” United States ex rel. Zizic v. Q2Administrators, LLC, 728 F.3d 228, 235 (3d Cir. 2013), Congress narrowed the the public disclosure bar so that more whistleblowers would file cases. […]
June 29, 2017
False Claims Act Legal News
Health First Entities Agree to Pay $3.5 Million to Resolve False Claims Act Lawsuit
Health First, Inc. and related entities have agreed to pay $3.5 million to resolve a False Claims Act lawsuit filed in 2014 by a whistleblower (the “relator”). The related entities include Health First, Inc., Health First Health Plans, Inc., Health First Medical Group, Holmes Regional Medical Center, Palm Bay Hospital, […]
June 26, 2017
False Claims Act Legal News
Court Finds That Labs Must Ensure That the Tests They Perform are Medically Necessary
On June 9, 2017, the United States District Court for the District of Columbia denied the defendant’s motion to dismiss in the False Claims Act lawsuit titled U.S. et al. ex rel. Tina D. Groat v. Boston Heart Diagnostics Corp., No. CV 15-487 (RBW), 2017 WL 2533341, at *1 (D.D.C. […]
June 23, 2017
Healthcare Fraud
When Does a Drug Manufacturer’s Savings Card Program or Discount Coupon Violate the Anti-Kickback Statute?
A drug manufacturer’s savings card program or discount coupon under which individuals who have Medicare Part D prescription drug coverage receive discounts may violate the Anti-Kickback Statute (“AKS”), unless the drug being purchased is statutorily excluded from Part D coverage. The key here is that the drug must be excluded […]
June 21, 2017
Healthcare Fraud
Pharmacy Discount Programs Can Lead to a Violation of the False Claims Act
Retail pharmacies that offer a discount drug pricing program to consumers must charge Medicare the same prices for drugs that they charge consumers who participate in those programs. To do otherwise violates the False Claims Act (“FCA”). The specific question is whether a pharmacy that offers a discount drug pricing […]
June 19, 2017
False Claims Act Information
Common Challenges With the Qui Tam Seal Requirement: What Whistleblowers Can Expect
One of the various procedural requirements imposed on whistleblowers is that they file their cases “under seal.” Not much is explained in the False Claims Act (“FCA”) as to what that means, other than the general understanding that no notification of the filing to the defendant takes place, what is […]
June 15, 2017
False Claims Act Legal News
District Court Rejects the Industry-Wide Public Disclosure Bar, Part II
In Part I of this blog series, we discussed the False Claims Act (“FCA”)’s public disclosure bar and the so called industry-wide public disclosure bar. In this blog post, we will examine a 2017 qui tam case that discusses and rejects the industry-wide public disclosure bar. An industry-wide public disclosure bar […]
June 13, 2017
False Claims Act Legal News
District Court Rejects the Industry-Wide Public Disclosure Bar, Part I
The False Claims Act (“FCA”) permits private individuals, known as relators, to sue on the Government’s behalf to recover funds that were fraudulently or falsely obtained from the Government. If a relator successfully recovers money for the Government, the FCA provides that the relator is entitled to a substantial percentage […]
June 7, 2017
False Claims Act Information
The Unwritten Nexus Requirement: Requiring a Connection Between Federal Funds and False Claims Under the False Claims Act
The federal government provides funding to an incredible number of non-government entities through direct spending and grants. The False Claims Act (“FCA”) provides that anyone who presents “false or fraudulent claims” or who commits other similar offenses is subject to substantial penalties. “Claim” is defined as including any request for […]
June 5, 2017
Contractor Fraud
Fraud in Connection With Contract Preferences or Set-Asides for Small Businesses or Businesses Owned by Veterans, Service-Disabled Veterans, Women or Disadvantaged Minorities, Part II
In Part I of this blog series, we identified various government programs that are often the target of fraud. In this blog post, we will examine the types of fraud that are committed against these programs, as well as recent case examples of fraud. Types of Fraud Cases alleging violations […]
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