Articles and Blogs

False Claims Act Defense

9th Circuit Issues Blockbuster Medicare Advantage FCA Decision

[08/12/16]

Posted on August 12, 2016 in False Claims Act Defense

Published by: Hall Render

The 9th Circuit Court of Appeals just issued a blockbuster ruling in U.S. ex rel. Swoben v United Healthcare et al., ruling that United Healthcare, WellPoint, Aetna and other major health insurance providers must answer to a whistleblower’s complaint that they defrauded the Medicare Advantage program. The Medicare Advantage Program, also known as Medicare... READ MORE

Massive Penalty Spike Darkens the FCA Landscape

[06/30/16]

Posted on June 30, 2016 in False Claims Act Defense

Written by: David B. Honig

In November 2015, the Bipartisan Budget Act of 2015 went into effect. One aspect of that act was the Federal Civil Penalties Inflation Adjustment Act Improvements Act of 2015. The new law required that the Program Fraud Civil Remedies Act and the False Claims Act (“FCA”) penalties be “corrected” to adjust for inflation since... READ MORE

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Supreme Court Accepts Implied Certification – With a Twist

[06/16/16]

Posted on June 16, 2016 in False Claims Act Defense

Written by: David B. Honig

The U.S. Supreme Court issued its decision today in Universal Health Services, Inc. v. United States ex rel. Escobar, and it will have an enormous effect on False Claims Act (“FCA”) cases throughout the nation. In Escobar, the FCA case was based upon the theory that counseling was provided by practitioners who were not properly... READ MORE

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7th Circuit Rules “Usual and Customary Pricing” Can Include Discount Programs

[05/31/16]

Posted on May 31, 2016 in False Claims Act Defense

Written by: David B. Honig

A recent whistleblower case could have a significant impact on Medicare Part D charge limits and corresponding reimbursement and could have ripple effects for aspects of other Medicare programs. The Seventh Circuit Court of Appeals ruled that reduced prescription prices offered by a large retail pharmacy (here Kmart) to participants enrolled in a popular discount... READ MORE

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Enforceability of FCA Releases Questioned

[05/30/16]

Posted on May 30, 2016 in False Claims Act Defense

Written by: David B. Honig

Releases of FCA claims my only be effective in very limited circumstances, the Second Circuit Court of Appeals ruled in a decision this week. In US ex rel. Ladas v. Exelis, Inc, et al., the court ruled that a pre-filing release is unenforceable as a matter of public policy – the encouragement of qui... READ MORE

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Massive Spike in FCA Penalties

[05/04/16]

Posted on May 4, 2016 in False Claims Act Defense

Written by: David B. Honig

In November 2015, the Bipartisan Budget Act of 2015 went into effect. One aspect of that act was the Federal Civil Penalties Inflation Adjustment Act Improvements Act of 2015. The new law required that the Program Fraud Civil Remedies Act and the False Claims Act (“FCA”) penalties be “corrected” to adjust for inflation since their... READ MORE

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Government Approval and Percentage in FCA Cases

[04/07/16]

Posted on April 7, 2016 in False Claims Act Defense

Published by: Hall Render

An Indiana Federal District Court just published an opinion on an issue of first impression in the Seventh Circuit, the ability of the government to reject or approve a settlement in a case in which they did not intervene. The court also opined on the ability of a whistleblower to enter into a settlement that... READ MORE

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Sixth Circuit Rejects HITECH FCA Complaint

[03/14/16]

Posted on March 14, 2016 in False Claims Act Defense

Written by: David B. Honig

The Sixth Circuit Court of Appeals, in US ex rel. Sheldon v. Kettering Health Network, affirmed the dismissal of a False Claims Act (“FCA”) suit alleging fraud based upon certifications of compliance with the HITECH Act and a data breach. The HITECH Act, or Health Information Technology for Economic and Clinical Health Act, encourages the... READ MORE

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Fourth Circuit Addresses Expanded Definition of “Original Source”

[02/17/16]

Posted on February 17, 2016 in False Claims Act Defense

Written by: David B. Honig

In 2010, the False Claims Act (“FCA”) was extensively amended to limit the public disclosure bar and to expand the ability of whistleblowers to qualify as “original sources” in qui tam litigation. This month, the Fourth Circuit Court of Appeals took an in-depth look at both provisions, in the case US ex rel. Moore & Co.... READ MORE

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60-Day Overpayment Rule Released

[02/11/16]

Posted on February 11, 2016 in False Claims Act Defense

Written by: David B. Honig

CMS has released its final 60-Day Overpayment Rule, providing clarity to the 2010 Affordable Care Act (“ACA”) amendment to the False Claims Act (“FCA”) that created FCA liability for failure to repay identified overpayment within 60 days. This is a long-awaited rule that provides essential clarity to an amendment that, until now, has vastly... READ MORE

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