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
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
Surgeon To Pay Up to $43 Million for FCA Fraud -
A Michigan vascular surgeon, Vasso Godiali, was sentenced to 80 months in prison for defrauding health care programs in connection with his submission of false claims for...more
5/30/2023
/ Blue Cross ,
Blue Shield ,
Coronavirus/COVID-19 ,
Criminal Convictions ,
False Claims Act (FCA) ,
Fraud ,
Healthcare ,
Investors ,
Medicaid ,
Medicare ,
Paycheck Protection Program (PPP) ,
Wire Fraud
Federal Judge Affirms $487 Million Judgment Against Medical Device Distributor for FCA Violations -
On May 12, 2023, US District Judge Wilhelmina M. Wright of the District of Minnesota affirmed the entry of a $487 million...more
Recent Interview With FCA Plaintiff Bar Attorneys Offers Key Insight into Trends in Anti-Kickback Litigation -
During a recent interview commemorating the 50th anniversary of the enactment of the Anti-Kickback Statute, two...more
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
A laboratory company based in Texas, Genotox Laboratories Ltd., recently reached an agreement with the federal government to resolve False Claims Act and Anti-Kickback Statute violations, stemming from allegations related to...more
4/10/2023
/ Anti-Kickback Statute ,
C-Suite Executives ,
Civil Monetary Penalty ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Fraud and Abuse ,
Healthcare Fraud ,
Medical Devices ,
Medicare ,
Settlement ,
Texas
Ophthalmology Distributer and Owner Oppose Government Request for $490 Million Award After Jury Verdict -
A federal jury in Milwaukee recently returned a verdict against the Cameron-Ehlen Group, Inc., d/b/a Precision Lens,...more
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 Files FCA Complaint Against Major Pharmacy Retailer Based on Alleged Violations of Controlled Substances Act -
On March 13, 2023, the Department of Justice (DOJ) announced that it filed a complaint in intervention...more
3/20/2023
/ Cannabis-Related Businesses (CRBs) ,
Controlled Substances Act ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Fraud ,
Healthcare Workers ,
Home Health Care ,
Investment ,
Nurses ,
Pharmaceutical Industry ,
Pharmacies ,
Securities and Exchange Commission (SEC) ,
Securities Fraud ,
Sherman Act ,
Staffing Agencies ,
Wage-Fixing
Headlines that Matter for Companies and Executives in Regulated Industries-
Government Wins $43 Million Verdict in False Claims Act Case -
On February 28, 2023, a federal jury in Minnesota handed down a $43 million...more
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
Top Reasons for 2022’s Downward Trend in False Claims Act Recoveries -
Following the US Department of Justice’s (DOJ) release of statistics regarding FCA settlements and judgments for the 2022 fiscal year, Law360 spoke...more
2/20/2023
/ CARES Act ,
Coronavirus/COVID-19 ,
Department of Justice (DOJ) ,
Enforcement Actions ,
False Claims Act (FCA) ,
Fees ,
Fraud and Abuse ,
Healthcare ,
Kickbacks ,
Medicare Advantage ,
Opioid ,
Private Equity ,
Proposed Amendments ,
Qui Tam ,
Settlement ,
Stark Law ,
Telehealth ,
Whistleblowers
DOJ’s FCA Recoveries Were Lowest Level Since 2008 -
On February 7, 2023, the US Department of Justice (DOJ) released statistics about False Claim Act (FCA) settlements and judgments for the 2022 fiscal year. Total...more
$31 Million Medicare Fraud Scheme Results in Two Convictions -
On January 30, 2023, a federal jury found two Florida physicians guilty for their involvement in a scheme to defraud Medicare of over $31 million. The two...more
2/6/2023
/ CARES Act ,
Coronavirus/COVID-19 ,
Criminal Convictions ,
Customs and Border Protection ,
Department of Justice (DOJ) ,
Durable Medical Equipment ,
False Claims Act (FCA) ,
False Statements ,
Fraud ,
Kickbacks ,
Medicare ,
Medicare Fraud ,
Paycheck Protection Program (PPP) ,
Settlement
Guilty Plea in $250 Million Federal Child Nutrition Fund Fraud Scheme -
A man from Brooklyn Park, Minneapolis, Minnesota, pled guilty for his involvement in a $250 million fraud scheme that exploited a federally-funded...more
1/30/2023
/ CARES Act ,
Coronavirus/COVID-19 ,
Economic Injury Disaster Loans ,
False Claims Act (FCA) ,
Forgery ,
Fraud ,
Guilty Pleas ,
IRS ,
Nursing Homes ,
Paycheck Protection Program (PPP) ,
Settlement
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
Florida Doctor Receives 20-Year Prison Sentence for Substance Abuse Treatment Fraud -
Following a guilty plea to conspiracy to commit health care and wire fraud, a Florida doctor was sentenced to 20 years in prison for...more
1/16/2023
/ CARES Act ,
Criminal Convictions ,
Drug Treatment ,
False Claims Act (FCA) ,
FIRREA ,
Fraud ,
Healthcare Fraud ,
Mail Fraud ,
Paycheck Protection Program (PPP) ,
Settlement ,
Substance Abuse ,
Telemarketing ,
Wire Fraud
Medical Device Company to Pay Over $700,000 To Resolve Criminal Allegations -
On January 4, 2023, a criminal information was filed in the Southern District of Illinois, in which Jet Medical Inc. (Jet), a medical device...more
1/6/2023
/ Civil Monetary Penalty ,
Coronavirus/COVID-19 ,
Criminal Penalties ,
Economic Injury Disaster Loans ,
False Claims Act (FCA) ,
Federal Food Drug and Cosmetic Act (FFDCA) ,
Food and Drug Administration (FDA) ,
Fraud ,
Healthcare Fraud ,
Medical Billing Codes ,
Medical Devices ,
Medicare ,
Paycheck Protection Program (PPP) ,
SBA ,
Settlement ,
Tax Evasion
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
Modernizing Medicine to Pay $45 Million to Settle False Claims Act Allegations -
Modernizing Medicine Inc. (ModMed), a Florida-based electronic health record (EHR) technology vendor, has agreed to pay $45 million to...more
11/4/2022
/ Anti-Kickback Statute ,
Coronavirus/COVID-19 ,
Cryptocurrency ,
Economic Injury Disaster Loans ,
Electronic Medical Records ,
False Claims Act (FCA) ,
Fraud ,
Health Care Providers ,
Paycheck Protection Program (PPP) ,
Qui Tam ,
Settlement
Headlines that Matter for Companies and Executives in Regulated Industries-
Amici Seek Dismissal of Qui Tam Suit From High Court -
Various medical, business and legal organizations are asking the US Supreme Court to...more
10/28/2022
/ Amicus Briefs ,
Anti-Money Laundering ,
Coronavirus/COVID-19 ,
Criminal Prosecution ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Fraud ,
Healthcare Fraud ,
Indictments ,
Motion to Dismiss ,
Paycheck Protection Program (PPP) ,
Qui Tam ,
Whistleblowers ,
Wire Fraud
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