Jury Clears SuperValu of Liability in Whistleblower FCA Prescription Pricing Case -
A federal jury in Illinois recently found SuperValu not liable in a whistleblower lawsuit that accused the company of overcharging the...more
3/10/2025
/ Anti-Kickback Statute ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Health Care Providers ,
Healthcare Fraud ,
Kickbacks ,
Medicare ,
Medicare Fraud ,
Prescription Drugs ,
SCOTUS ,
Settlement ,
Whistleblowers
Ninth Circuit Reverses Dismissal of FCA Suit -
On Tuesday, the Ninth Circuit reversed the district court’s grant of Express Scripts’ motion to dismiss a whistleblower’s lawsuit accusing Express Scripts of defrauding the US...more
2/10/2025
/ Appeals ,
Ciminelli v US ,
Department of Defense (DOD) ,
Dismissals ,
Enforcement Actions ,
False Claims Act (FCA) ,
Fraud ,
Litigation Strategies ,
SCOTUS ,
Stays ,
Whistleblowers
Massachusetts District Court Judge Applies Heightened Causation Standard in FCA Case -
On January 6, a District Court of Massachusetts judge granted summary judgment for defendants on allegations of violating the...more
1/27/2025
/ Anti-Kickback Statute ,
Causation ,
Compliance ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Health Care Providers ,
Healthcare Fraud ,
Kickbacks ,
Medicare ,
Medicare Advantage ,
Opioid ,
Paycheck Protection Program (PPP) ,
Qui Tam ,
SCOTUS ,
Settlement ,
Skilled Nursing Facility ,
Whistleblowers
Federal Government Urges Court of Appeals to Uphold Constitutionality of FCA Qui Tam Provisions -
In a brief filed earlier this week, the US federal government has urged the Eleventh Circuit Court of Appeals to uphold the...more
1/13/2025
/ Anti-Kickback Statute ,
Appeals ,
Appointments Clause ,
Article III ,
Constitutional Challenges ,
Coronavirus/COVID-19 ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Fraud ,
Health Care Providers ,
Healthcare Fraud ,
Medicare ,
Misrepresentation ,
National Institute of Health (NIH) ,
Pharmaceutical Industry ,
Qui Tam ,
SCOTUS ,
Settlement ,
Stark Law ,
Unconstitutional Condition ,
Whistleblowers
US Supreme Court Declines to Consider AKS ‘Willfulness’ Question -
On October 7, the US Supreme Court denied a petition in which a whistleblower asked the Court to decide whether a “willful” act under the federal...more
10/14/2024
/ Anti-Kickback Statute ,
Bribery ,
Criminal Conspiracy ,
Denial of Certiorari ,
False Claims Act (FCA) ,
Healthcare Fraud ,
Home Health Care ,
Kickbacks ,
Medicaid ,
Money Laundering ,
Popular ,
Scienter ,
SCOTUS ,
Telehealth ,
Whistleblowers
Previously, we discussed how the US Supreme Court’s opinion in Loper Bright Enterprises v. Raimondo and Relentless, Inc. v. Department of Commerce could create opportunities for private litigants to challenge health...more
7/30/2024
/ Centers for Medicare & Medicaid Services (CMS) ,
Chevron Deference ,
Department of Health and Human Services (HHS) ,
Health Care Providers ,
Healthcare ,
Loper Bright Enterprises v Raimondo ,
Payment Systems ,
Regulatory Agenda ,
SCOTUS ,
Secretary of HHS ,
Stark Law
Federal Court Dismisses $680 Million FCA Suit -
On July 23, a Maryland federal judge, Ellen L. Hollander, dismissed a $680 million False Claims Act (FCA) suit that was previously revived by the US Supreme Court. The suit...more
The US Supreme Court recently overturned its ruling in Chevron USA, Inc. v. Natural Resources Defense Council, Inc., changing the landscape for federal agency rulemaking and actions, particularly in the health care industry....more
On June 7, Adam Hart, a former employee of McKesson Corporation, filed a petition for certiorari to the US Supreme Court asking the Court to define the “willfulness” element of the Anti-Kickback Statute (AKS). United States...more
SCOTUS Declines to Hear False Claims Act Challenge -
On January 22, the US Supreme Court denied a petition to hear a challenge to a Fifth Circuit Court of Appeals decision that upheld scienter and False Claims Act (FCA)...more
1/29/2024
/ Confidential Information ,
Conspiracies ,
Denial of Certiorari ,
False Claims Act (FCA) ,
Insider Trading ,
Medicare Fraud ,
Misappropriation ,
Reimbursements ,
SCOTUS ,
Securities Fraud ,
Sentencing
DOJ Enters Into DPAs with Former Deerfield Traders and CMS Consultant -
On July 24, 2023, the US Department of Justice (DOJ) entered into deferred prosecution agreements with Theodore Huber and Robert Olan, former traders...more
7/31/2023
/ Centers for Medicare & Medicaid Services (CMS) ,
Clinical Laboratory Testing ,
Conflicts of Interest ,
Criminal Conspiracy ,
Criminal Convictions ,
Deferred Prosecution Agreements ,
Department of Justice (DOJ) ,
Insider Trading ,
Investment Adviser ,
Kelly v United States ,
Kickbacks ,
Physicians ,
SCOTUS ,
Securities and Exchange Commission (SEC) ,
Settlement ,
Special Purpose Acquisition Companies (SPACs)
New FCA Filings Point to Future Path Forward For Companies -
The US Supreme Court recently ruled in United States ex rel. Proctor v. Safeway Inc. and United States ex rel. Schutte, et al. v. SuperValu Inc. et al. that...more
Supreme Court Justices Signal Skepticism of Qui Tam Constitutionality -
On Friday, June 16, the US Supreme Court ruled that the US Department of Justice (DOJ) has the authority to dismiss qui tam suits brought under the...more
On June 16, 2023, in United States, ex rel. Polansky v. Executive Health Resources, Inc., the US Supreme Court addressed the government’s authority to dismiss a qui tam False Claims Act (FCA) suit over a relator’s objection...more
6/22/2023
/ Article II ,
Constitutional Challenges ,
Corporate Misconduct ,
Dismissals ,
False Claims Act (FCA) ,
Federal Rules of Civil Procedure ,
Fraud ,
Healthcare ,
Inpatient Billing ,
Investigations ,
Qui Tam ,
Relators ,
SCOTUS ,
United States ex rel Polansky v Executive Health Resources Inc ,
Whistleblowers
Recent Filings Shed Light on DOJ’s View of Supreme Court’s Recent FCA Ruling -
On June 1, 2023, the US Supreme Court explained that an assessment of a defendant’s subjective beliefs — rather than what an objectively...more
6/19/2023
/ Chief Compliance Officers ,
Criminal Convictions ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Fraud ,
Healthcare Fraud ,
IRS ,
Medicare ,
Opioid ,
Pharmacies ,
Pharmacist ,
Scienter ,
SCOTUS ,
Tax Fraud ,
Wire Fraud
Court Unseals Charges Alleging Nearly $15 Million in Fraudulent PPP Loans -
Earlier this week, federal prosecutors in the Southern District of New York announced the unsealing of a criminal complaint charging six...more
6/12/2023
/ Criminal Conspiracy ,
False Claims Act (FCA) ,
Falsified Documents ,
Financial Institutions ,
Fraud ,
IRS ,
Kickbacks ,
Medicaid ,
Medicare ,
Paycheck Protection Program (PPP) ,
SCOTUS ,
Sentencing ,
Tax Returns ,
US ex rel Tracy Schutte et al v SuperValu Inc et al ,
Wire Fraud
The US Supreme Court brushed aside novel assertions from two pharmacy retailers on June 1 and ruled unanimously that False Claims Act liability hinges on whether defendants subjectively believed their claims were “false.” In...more
6/8/2023
/ Appeals ,
Drug Pricing ,
Fair Credit Reporting Act (FCRA) ,
False Claims Act (FCA) ,
Healthcare ,
Medicaid ,
Medicare ,
Pharmacies ,
Prescription Drugs ,
Reimbursements ,
Safeco Insurance Co of America v Burr ,
SCOTUS ,
US ex rel Thomas Proctor v Safeway Inc ,
US ex rel Tracy Schutte et al v SuperValu Inc et al ,
Whistleblowers
Supreme Court FCA Scienter Ruling Revives Fraud Lawsuits Against Safeway and SuperValu On Thursday, the US Supreme Court issued its highly anticipated ruling regarding the threshold of liability under the False Claims Act...more
6/5/2023
/ Drug Pricing ,
False Claims Act (FCA) ,
Fraud ,
Healthcare ,
Oral Argument ,
Pharmaceutical Industry ,
Pharmacies ,
Prescription Drugs ,
Reasonable Interpretations ,
Safeco ,
Safeco Insurance Co of America v Burr ,
Scienter ,
SCOTUS ,
US ex rel Thomas Proctor v Safeway Inc ,
US ex rel Tracy Schutte et al v SuperValu Inc et al
Anticipated Landmark Supreme Court Decision May Be Anything But On -
April 18, 2023, the US Supreme Court heard oral arguments in a set of highly anticipated cases regarding the scienter—or knowledge—provision of the False...more
4/24/2023
/ Appeals ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Fraud ,
Healthcare Fraud ,
Kickbacks ,
Oral Argument ,
Penalties ,
Pharmacy Benefit Manager (PBM) ,
Restitution ,
SCOTUS
Supreme Court to Hear US Government in FCA Scienter Oral Argument -
On March 20, 2023, the US Supreme Court agreed to allow the federal government to participate in oral argument in the Supreme Court’s review of the...more
3/27/2023
/ Bribery ,
Deferred Prosecution Agreements ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Foreign Corrupt Practices Act (FCPA) ,
Generic Drugs ,
Insurance Fraud ,
Medicaid ,
Medicare ,
Oral Argument ,
Scienter ,
SCOTUS ,
Securities and Exchange Commission (SEC)
DOJ Issues Corporate Self-Disclosure Policy -
The US Department of Justice (DOJ) released a Voluntary Self-Disclosure Policy that sets a consistent standard for corporate self-disclosures for all US Attorney’s Offices. The...more
2/27/2023
/ Appeals ,
Corporate Misconduct ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Fraud ,
Health and Welfare Plans ,
Medicaid ,
Medicare ,
NBA ,
Proposed Amendments ,
Restitution ,
SCOTUS ,
Self-Disclosure Requirements ,
Whistleblowers
US Supreme Court to Address FCA’s Scienter Requirement in Safeway Case -
The US Supreme Court granted certiorari to resolve a circuit split regarding whether a defendant “knowingly” violates the False Claims Act (FCA) if...more
Former Theranos Executive Ramesh “Sunny” Balwani Sentenced to Nearly 13 Years -
On December 7, 2022, Ramesh “Sunny” Balwani, a former Theranos executive, was sentenced to nearly 13 years in prison, and three years of...more
SCOTUS Denies Cert In Cases Addressing FCA Pleadings Requirements -
On Monday, October 17, 2022, the US Supreme Court rejected three petitions asking the Court to resolve a circuit split regarding the Rule 9(b)...more
10/21/2022
/ CIGNA ,
Denial of Certiorari ,
False Claims Act (FCA) ,
Federal Health Care Programs (FHCP) ,
Health Care Providers ,
Kickbacks ,
Medicare ,
Medicare Advantage ,
SCOTUS ,
Solicitor General ,
TRICARE ,
Whistleblowers
SCOTUS Raises the Bar for Proof of Intent Under the Controlled Substances Act -
This week, the US Supreme Court issued a ruling in Ruan v. United States requiring subjective intent of wrongdoing in order to convict...more
7/1/2022
/ Controlled Substances Act ,
Criminal Investigations ,
Department of Justice (DOJ) ,
Fraud ,
Kickbacks ,
NBA ,
Proof of Intent ,
Reimbursements ,
SCOTUS ,
Settlement ,
Stark Law