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March 29, 2017
Grant Fraud
How to Calculate Damages for False Claims Act Cases Based on Research Grant Fraud
The federal government, through its agencies, offers grant funding opportunities to private individuals and entities. Numerous federal agencies offer grants, including the Department of Defense, Health and Human Services and the Department of Energy. Often federal grants are aimed at funding innovative research. In a nutshell, the grant process involves […]
March 27, 2017
False Claims Act Legal News
Another Court Provides Strong Support for Whistleblower Use of Confidential Employer Documents to Expose Alleged Fraud
One of the ways in which companies attempt to discourage whistleblowing or to punish actual whistleblowers is by asserting legal claims against them for using company documents, sometimes in violation of employment agreements or other company employee policies or under various tort laws.[1] In one recent case, for example, the corporate […]
March 24, 2017
Healthcare Fraud
The Federal Anti-Kickback Statute
The federal Anti-Kickback Statute, 42 U.S.C. § 1320a-7b(b), (“AKS”) arose out of congressional concern that remuneration provided to those who can influence healthcare decisions would result in goods and services being provided that are medically unnecessary, of poor quality, or harmful to a vulnerable patient population. To protect the integrity […]
March 22, 2017
False Claims Act Information
Meeting the Materiality Requirement of the False Claims Act in Cases Brought by Qui Tam Whistleblowers
The False Claims Act’s Materiality Requirement Under the express language of the False Claims Act (“FCA”), material means having a “natural tendency to influence or be capable of influencing” the government’s decision to pay a claim. 31 U.S.C. § 3729(a)(4). The Escobar Decision Under the 2016 Supreme Court case of […]
March 20, 2017
False Claims Act Information
Fraudulent Inducement as a Legal Theory Under the Qui Tam Provisions of the False Claims Act
While many defendants may assert that fraudulent inducement is not a viable theory of liability in a qui tam case under the False Claims Act (“FCA”), the truth is that the plentiful and better-reasoned authorities to consider this issue support FCA liability for defrauding the FDA. See United States v. […]
March 15, 2017
Rule 9(b)
Pleading Standards in the Eighth Circuit
Federal Rule of Civil Procedure Rule 9(b) Relators in qui tam cases under the False Claims Act (“FCA”) face considerable challenges in meeting pleading requirements in many circuits, including the 8th Circuit. The Rule 9(b) standard in the Eighth Circuit is well described by the Court in United States ex […]
March 13, 2017
False Claims Act Information
False Claims Act Cases Based on Fraudulent Inducement
Liability under the False Claims Act (“FCA”) for fraud in the inducement is established when eligibility to receive funds under a government program was procured by misstatements or other misleading actions. Courts have repeatedly held fraudulent inducement is a viable theory of liability under the FCA. See United States ex […]
March 8, 2017
Healthcare Fraud
Whistleblower Lawsuits Against Medicare Advantage Organizations
In addition to the big qui tam case against UnitedHealth Group that has received so much press recently, there is a similar whistleblower case pending in federal court in Texas alleging False Claims Act (“FCA”) claims against a medical coding company, Censeo Health, L.L.C., and several Medicare Advantage organizations (“MAOs”). […]
March 6, 2017
False Claims Act Legal News
Senator Chuck Grassley and Seema Verma Discuss the Importance of the False Claims Act to CMS
On February 16, 2017, the Senate Finance Committee held a confirmation hearing for Seema Verma to become the nation’s next Administrator of the Centers for Medicare and Medicaid Services (“CMS”). During her testimony, Senators raised wide-ranging questions about the best ways to maintain the quality of the Medicare and Medicaid […]
March 1, 2017
Healthcare Fraud
Laboratories May be Liable under the False Claims Act for Submitting Claims for Screening Tests to Medicare
Laboratory tests are not medically necessary when they do not “determine a disease or illness. . . or medically or surgically manage an illness.” Strand Analytical Labs., LLC v. Burwell, 2015 WL 4603258, at *17 (S.D. Ind. July 30, 2015) (“The plain meaning of the words diagnose and treat do […]
February 27, 2017
Healthcare Fraud
A Laboratory’s Liability for Medically Unnecessary Lab Tests under the False Claims Act, Part II
In Part I of this blog series, we discussed when lab tests are considered “reasonable and necessary” under the False Claims Act (“FCA”) and therefore reimbursable by government health insurers such as Medicare and Medicaid, as well as a laboratory’s responsibility for ensuring that lab tests submitted for reimbursement are […]
February 24, 2017
Healthcare Fraud
A Laboratory’s Liability for Medically Unnecessary Lab Tests under the False Claims Act, Part I
This article addresses the liability of a diagnostic testing laboratory under the False Claims Act (“FCA”) for conducting lab tests that are ordered by a doctor and submitting claims for payment to government health insurers, such as Medicare and Medicaid, for those lab tests when those tests are not medically […]
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