Recent Supreme Court Ruling Gives Whistleblowers More Time
SCOTUS delivered a unanimous opinion on May 13, 2019 affirming a Eleventh Circuit ruling that (1) the extended limitations period of up to 10 years applies to whistleblower-initiated False Claims Act lawsuits in which the government has declined to intervene and (2) whistleblowers in nonintervened cases are not "the official of the United States" referred to by the statute. This decision resolved a three circuit split. More
Where Does Attorney General William Barr Stand on the False Claims Act?
William Barr was confirmed as Attorney General by the Senate a few months ago, after testifying before the Senate Judiciary Committee in a hearing on January 15, 2019. Immediately following the hearing, The National Whistleblower Center ("NWC") Whistleblower Protection Blog reported with a sigh of relief that Barr had committed to "diligently enforce" the False Claims Act. This post also included a statement from NWC Executive Director Stephen M. Kohn, calling this a "major victory for all whistleblowers," since Barr was historically opposed to the qui tam provision in the False Claims Act that enables whistleblowers to sue on behalf of the government if they have independent knowledge that fraud is taking place. More
The Brand Memo – Everything You Need to Know
The Brand memo was issued in January 2018 by then-Associate Attorney General Rachel Brand, limiting the use of guidance documents in civil enforcement actions and preventing DOJ attorneys from using informal agency guidance as binding law. To understand more, it is important to first understand the Sessions memo. More
Durable Medical Equipment Provider Agrees To Pay $1.6 Million To Resolve False Claims Allegations
U.S. Attorney for Utah, John W. Huber, announced on December 11, 2018, that the durable medical equipment ("DME") company Western Medical Group agreed to pay $1,634,844 million to settle False Claims Act allegations. The settlement is the result of two qui tam actions filed by whistleblowers in December 2013 and February 2014. More
Drug Maker Actelion Agrees to Pay $360 Million to Settle False Claims Act Investigation Into Kickbacks
The pharmaceutical company Actelion Pharmaceuticals US, Inc. ("Actelion"), based in South San Francisco, California, has agreed to pay $360 million to resolve claims that it illegally funneled kickbacks through a patient-assistance charity. Federal prosecutors allege in a press release on December 6, 2018 that Actelion "illegally used a foundation as a conduit to pay the copays of thousands of Medicare patients taking Actelion's pulmonary arterial hypertension drugs." These actions are in violation of the False Claims Act. More
Largest Ever Recovery in a Single-State False Claims Act Lawsuit: $330 Million Settlement with Sprint Communications
New York Attorney General Barbara D. Underwood and Acting Tax Commissioner Nonie Manion announced a record $330 million settlement with Sprint Communications on December 21, 2018. This settlement is not only the largest-ever recovery by the New York Attorney General resulting from an action filed under the New York False Claims Act, but it is also the largest-ever recovery by a single state in an action brought under a state false claims act. More
The Virginia Birth-Related Neurological Injury Compensation Program Settles for $20.7 Million
The Virginia Birth-Related Neurological Injury Compensation Program ("The Program") and the Virginia Birth-Related Neurological Injury Compensation Fund ("The Fund") have recently agreed to pay a $20.7 million settlement to resolve FCA allegation brought against them by a whistleblower suit. Relators allege that the defendants knowingly caused numerous Program participants to submit false claims to Medicaid. By law, Medicaid is the "payer of last resort" for all healthcare claims for a covered beneficiary, meaning if another insurer or program has the responsibility to pay for medical costs incurred by a Medicaid-eligible individual, that entity is generally required to pay all of or part of the costs of the claim before Medicaid makes any payment. If a third party is liable to pay for part of a Medicaid participant's care, "Medicaid will only pay that part of the care which is over and above the amount covered by the third party."[1] The text of Va. Code Ann. §38.2-5009 specifically says that the Program will not cover any items or expenses that would be covered "under the laws of any state or the federal government except to the extent prohibited by federal law." However, the Program and the Fund made themselves the de facto payers of last resort, improperly shifting payment onto the Medicaid program. More
Why Do So Many False Claims Cases Settle Before Trial?
It is widely recognized that many more False Claims Act (FCA) cases settle than go to trial.[1] While it is difficult to determine the exact proportion of cases that settle vs. cases that are tried, comprehensive reports on FCA developments published semi-annually indicate about a 16:1 ratio of notable settlements to verdicts/ judgments.[2] More
Medicare Advantage Provider to Pay $270 Million to Settle False Claim Act Liabilities
HealthCare Partners Holdings LLC, doing business as Davita Medical Holdings LLC (DaVita), has agreed to settle a False Claims Act liability case and will pay $270 million to the United States Government. DaVita, headquartered in El Segundo, California, did not admit fault. Relators allege that DaVita was providing inaccurate information that caused Medicare Advantage Plans to receive inflated Medicare payments. More
The Government Fights Back Against Ambulance Fraud: A Recent $21 Million Settlement and Other Related Cases
The U.S. Government has successfully combatted several instances of ambulance fraud this past year, by intervening in False Claims Act (FCA) qui tam suits and by pursuing a criminal health care fraud case against an ambulance company owner. These cases against AmeriCare, Hart to Heart, and the owner of Tonieann EMS and Rosenberg EMS, mainly involve allegations that these companies systematically billed government-provided insurance for medically unnecessary ambulance transports. However, a recently-resolved case against Paramedics Plus and several affiliates involved allegations of an illegal kickback scheme enacted to win and maintain exclusive ambulance contracts. More
Subscribe to this blog's feedRecent Posts
- Famous Whistleblowers and Their Impact on America
- New Formal Guidelines on "Cooperation Credit" for False Claims Act Defendants
- Failing to Meet Cybersecurity Requirements May Expose Company to False Claims Act Liability
- Carolina Physical Therapy and Sports Medicine, Inc. Settles False Billing Allegations and Agrees to Pay $790,000
- Pharmaceutical Executive Found Guilty of Racketeering Conspiracy in Landmark Bribery Case Involving False Claims
- Government Takes a Hard Line on Fraudulent Donations to Patient Assistance Programs
- Pharmaceutical Manufacturer US WorldMeds LLC Pays $17.5 Million to Settle False Claims Act Allegations
- Can I Be Compensated For Being a Whistleblower?
- Sutter Health Settles False Claims Act Allegations for $30 Million
- Duke University Pays U.S. Government $112.5 Million to Settle False Claims Act Allegations
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