Articles and Blogs

False Claims Act Defense

The Eighth Circuit Applies Escobar Materiality Test

[10/20/16]

Posted on October 20, 2016 in False Claims Act Defense

Published by: Hall Render

The Eighth Circuit Court of Appeals yesterday applied the materiality standard enunciated by the Supreme Court in Universal Health Services, Inc. v. United States ex rel. Escobar to a False Claims Act (“FCA”) case alleging fraudulent inducement. In United States ex rel. Miller v. Weston Educational Inc., d/b/a Heritage College, two whistleblowers alleged Heritage College altered grade and attendance... READ MORE

Seventh Circuit Says “Medical Necessity” FCA Claims Require Specifics

[09/07/16]

Posted on September 7, 2016 in False Claims Act Defense

Published by: Hall Render

Last week, the Seventh Circuit Court of Appeals handed down its decision in  US ex rel. Presser v. Acacia Mental Health Clinic, LLC.¹  The FCA case was brought by a nurse practitioner whistleblower who alleged that services being provided were not medically necessary. The court affirmed dismissal under Rule 9(b) for failure to plead fraud... READ MORE

Government Challenges “Materiality” Standard of Escobar

[09/06/16]

Posted on September 6, 2016 in False Claims Act Defense

Published by: Hall Render

Ever since the Supreme Court’s June 16, 2016 decision in Universal Health Services, Inc. v. United States ex rel. Escobar, a False Claims Act (“FCA”) case upholding the theory of implied certification, significant discussion has commenced regarding the Court’s “new” FCA materiality standard. How the appellate courts define materiality under the FCA, post-Escobar, will... READ MORE

End of the 60-Day Refund Road for One New York Hospital System

[08/26/16]

Posted on August 26, 2016 in False Claims Act Defense

Published by: Hall Render

Executive Summary On August 23, 2016, three New York hospitals (the “Hospitals”) and a New York health system, which operated and coordinated a nonprofit network that included the Hospitals (collectively, the “Health System”), entered into settlement agreements (the “Settlement”) for approximately $3 million with the United States and the State of New York. The... READ MORE

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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