In this episode, Akin Gump health care partners Kelly Cleary and Robert Salcido discuss the health care industry and how COVID-19 has impacted the industry and affected or driven legislative and regulatory activity.
Among...more
9/22/2020
/ CARES Act ,
Conflicts of Interest ,
Coronavirus/COVID-19 ,
Drug Pricing ,
Enforcement Actions ,
False Claims Act (FCA) ,
Health Care Providers ,
Healthcare Fraud ,
Legislative Agendas ,
Physicians ,
Regulatory Oversight ,
Stark Law ,
Telehealth ,
Telemedicine
Key Points:
- False Claims Act plaintiff cannot use discovery to satisfy Fed. R. Civ. P. 9(b).
- Payment of fair market value is a dispositive defense in FCA actions alleging a violation of the Anti-Kickback...more
1/28/2020
/ Anti-Kickback Statute ,
Centers for Medicare & Medicaid Services (CMS) ,
Discovery ,
False Claims Act (FCA) ,
Federal Rules of Civil Procedure ,
FRCP 9(b) ,
Health Care Providers ,
Medicaid ,
Medicare ,
Qui Tam ,
Relators ,
Rulemaking Process ,
Stark Law ,
Whistleblowers
• Reasonable disagreement among clinicians, by itself, does not result in a false claim.
• Clinical judgment must be objectively false to constitute an FCA violation.
• A clinical judgment may only be objectively false...more
10/11/2019
/ Billing ,
False Billing ,
False Claims Act (FCA) ,
Federal Contractors ,
Guilty Pleas ,
Health Care Providers ,
Healthcare Fraud ,
Hospice ,
Jury Instructions ,
Medicare ,
Overpayment ,
Physicians ,
Qui Tam ,
Relators ,
Scienter
• Escobar doctrinally and conceptually transformed the FCA.
• Relators and the government have developed strategies to neutralize Escobar.
• Defendants must avoid certain new traps that could enhance their exposure to...more
6/24/2019
/ Department of Justice (DOJ) ,
Dismissals ,
Enforcement Actions ,
False Claims Act (FCA) ,
Fraud and Abuse ,
Government Agencies ,
Health Care Providers ,
Healthcare Fraud ,
Qui Tam ,
Relators ,
The Granston Memo ,
Universal Health Services Inc v United States ex rel Escobar
• In an unusual move, the government has decided to pursue a False Claims Act (FCA) suit against a private equity firm based on an alleged commission scheme at its pharmacy portfolio company to promote sales of products...more
3/22/2018
/ Anti-Kickback Statute ,
Civil Monetary Penalty ,
Drug Compounding ,
Due Diligence ,
False Claims Act (FCA) ,
Federal Funding ,
Fraud and Abuse ,
Health Care Providers ,
Healthcare Fraud ,
Investors ,
Medical Reimbursement ,
Patients ,
Pharmaceutical Industry ,
Pharmacies ,
Portfolio Companies ,
Prescription Drugs ,
Private Equity Firms ,
Qui Tam ,
Risk Mitigation ,
Treble Damages ,
TRICARE
Key Points:
- Learn the latest case law developments regarding what evidence the government or the relator must establish to prove that the defendant “recklessly” interpreted a statute or regulation in violation of the...more
9/29/2016
/ Ambiguous ,
Centers for Medicare & Medicaid Services (CMS) ,
Evidence ,
False Claims Act (FCA) ,
Health Care Providers ,
Lack of Interpretive Guidance ,
Overpayment ,
Reasonable Interpretations ,
Relators ,
Reverse False Claims ,
Scienter
An issue every health care entity that submits claims to the government must frequently confront is when and how to disclose an overpayment to the government. This issue arises when, for example, an employee expresses concern...more
I. Stark Law and False Claims Act -
The FCA has become the primary enforcement vehicle for the Ethics in Patient Referrals Act, better known as the Stark Law. There are now more than 150 public cases citing to both the...more
If you read one thing…
- The False Claims Act’s (FCA) language, structure, court precedent and purpose limit its application to only regulatory breaches that are conditions of payment and not conditions of...more