Examining the Distinction Between Conditions of Participation Versus Conditions of Payment

The statutory requirements of the False Claims Act are highly specific, requiring a precise intent to defraud the government out of taxpayer dollars. An emerging issue across several federal courts involves the pivotal distinction between conditions for participation in Medicare or Medicaid versus conditions for reimbursement for patients enrolled in […]

Tennessee District Court Approves Statistical Sampling in Pivotal False Claims Act Case

As we discussed yesterday, the False Claims Act is often triggered by widespread, pervasive, long-term fraudulent behavior–resulting in voluminous records and hundreds of thousands of invoices evidencing the fraudulent misconduct. As a result, courts have begun to consider whether the use of a statistical random sample of admissions or patient […]

District Court Allows Use of Sampling in Complex False Claims Act Case Against LifeCare

As you can likely imagine, the sheer volume of evidence that emerges during the investigation and discovery phases of a False Claims Act case can quickly overwhelm the court and create logistical difficulty for the party tasked with presenting such evidence to support an assertion of liability. For instance, if […]

Pennsylvania Appellate Court Considers Confidential Nature of Qui Tam Actions in Light of Insurance Policy

In the corporate world, companies often take out extensive insurance policies to protect against the inevitable financial harms following a civil lawsuit. Much like any other insurance policy, the insurer will usually include language in the policy terms excluding coverage for any pending lawsuits filed or commenced prior to the […]

Shire Pharmaceuticals to Pay $56 Million to Settle False Claims Act Allegations

According to a recent announcement by the Department of Justice, Shire Pharmaceuticals has agreed to pay $56 million to settle claims it fraudulently marketed the popular attention-deficit drug Adderall and thereafter submitted claims to U.S. government healthcare programs for reimbursement. The allegations differ from the oft-cited problem of “off-label marketing,” […]