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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 […]
February 22, 2017
Healthcare Fraud
“Medically Necessary” Ambulance Services Under the False Claims Act
A non-intervened False Claims Act case filed against Medstar, an ambulance company, settled for $12.7 million on January 17, 2017. The qui tam case was filed on October 4, 2013 in the Federal District Court of Massachusetts under the caption United States ex rel. Dale Meehan v. MedStar et als, […]
February 20, 2017
False Claims Act Information
Can You Sue A Company Under the False Claims Act If You Don’t Have Copies of Claims for Payment?
A common problem for potential whistleblowers trying to start a case under the False Claims Act (“FCA”) is that they do not always have access to individual claims for payment made by the target defendant. Often this results because the employee does not work in the finance or billing division […]
February 15, 2017
False Claims Act Information
Using Differences in Geographic Scope to Avoid the First-to-File Rule in False Claims Act Whistleblower Cases
As recounted in our previous blog entry, the federal False Claims Act (“FCA”) contains a first-to-file rule, which provides that “[w]hen a person brings an action under [the False Claims Act] no person other than the Government may intervene or bring a related action based on the facts underlying the […]
February 13, 2017
False Claims Act Information
Piercing the Attorney Client Privilege in Qui Tam Whistleblower Cases Under the False Claims Act
It is well established that the scope and conduct of discovery are well within the sound discretion of the trial court. Gaul v. Zep Mfg. Co., No. 03-2439, 2004 U.S. Dist. Lexis 1990, at *3 (E.D. Pa. Feb. 5, 2004) (quoting Marroquin-Manriquez v. Immigration and Naturalization Serv., 699 F.2d 129, 134 […]
February 9, 2017
False Claims Act Information
Avoiding Application of the False Claims Act’s First-to-File Bar
The False Claims Act’s first-to-file rule provides that “[w]hen a person brings an action under [the False Claims Act], no person other than the Government may intervene or bring a related action based on the facts underlying the pending action.” 31 U.S.C. § 3730(b)(5). This blog provides an overview of […]
January 25, 2017
Healthcare Fraud
Medicare Advantage Fraud Part I: Presentment of False Claims by Medical Providers to Medicare Advantage Organizations
Medicare fraud is one of the prime drivers of litigation under the False Claims Act (“FCA”). Under traditional Medicare, service providers are directly reimbursed with federal government funds. In 2003, Congress significantly expanded the availability of an alternative to traditional Medicare known as Medicare Advantage. Medicare Advantage differs from traditional […]
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