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
• Escobar’s two-part implied false certification test is mandatory in the 9th Circuit.
• Though couched as adopting the Escobar standard, the 9th Circuit panel’s decision may actually undermine Escobar’s overarching...more
• Under the FCA there are multiple circuit court splits related to how power should be allocated between the United States and the relator and whether the relator has contributed sufficient value to merit obtaining a...more
2/13/2018
/ Amended Complaints ,
Department of Justice (DOJ) ,
Dismissals ,
False Claims Act (FCA) ,
First-to-File ,
FRCP 9(b) ,
Frivolous Lawsuits ,
Judgment on the Merits ,
Motion to Dismiss ,
Public Disclosure ,
Qui Tam ,
Relators ,
Split of Authority ,
Statute of Limitations ,
Tolling
• How have appellate courts applied the Supreme Court’s ruling in Escobar?
• If the government is aware of the relator’s allegation, but does not undertake any administrative action to address the defendant’s alleged...more
10/11/2017
/ ANSI ,
Centers for Medicare & Medicaid Services (CMS) ,
DCAA ,
Department of Justice (DOJ) ,
Department of the Interior ,
False Claims Act (FCA) ,
Food and Drug Administration (FDA) ,
Genentech ,
Government Agencies ,
Materiality ,
Medical Devices ,
Qui Tam ,
Relators ,
Side Effects ,
Universal Health Services Inc v United States ex rel Escobar ,
Warning Labels
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
If you read one thing...
- Learn what evidence the government or the relator must establish to prove that the defendant “recklessly” interpreted a statute or regulation in violation of the FCA.
- Understand...more