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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 […]

Morganti Legal’s Summer Student Earns Victory in Chicago

Morganti Legal’s 2016 summer student, Joseph Tung, along with partner Adam Fucile were awarded overall winning team of The Regional Transactional LawMeet Competition held on February 24, 2017 at Northwestern University School of Law in Chicago. Joseph and Adam, on behalf of University of Detroit Mercy School of Law, competed against eleven other […]

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”).   […]

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 […]

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 […]

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 […]

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 […]

“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, […]

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 […]

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 […]

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 […]

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 […]