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Medicaid Medicare Federal Contractors

Medicaid is a partnership program between states and the federal government to provide healthcare coverage for lower income individuals, people with disabilities, older people, and certain families with... more +
Medicaid is a partnership program between states and the federal government to provide healthcare coverage for lower income individuals, people with disabilities, older people, and certain families with children.  less -
American Conference Institute (ACI)

[Virtual Conference] 19th Annual BIG FOUR Pharmaceutical Pricing Boot Camp - June 23rd - 24th, 9:00 am - 5:30 pm EDT

Attend ACI's 19th Annual BIG FOUR Pharmaceutical Pricing Boot Camp for an intensive online bootcamp that will provide you with a thorough understanding of essential government contracting processes and pricing concepts for...more

Hogan Lovells

HHS rescinds policy regarding notice-and-comment rulemaking – implications for health care industry

Hogan Lovells on

On February 28, 2025, the Department of Health and Human Services (“HHS” or “the Department”) issued a Policy Statement rescinding long-standing HHS guidance regarding the use of notice-and-comment rulemaking to adopt certain...more

Fox Rothschild LLP

FCA 101: Falsity

Fox Rothschild LLP on

To prove a False Claim under the False Claims Act (FCA), the government or relator must establish three elements: 1.Falsity; - 2.Knowledge; and - 3.Materiality. In this blog post, we will explore the Falsity element. ...more

Cozen O'Connor

Are You Secure? DOJ’s Cyber-Fraud Initiative and Heightened FCA Enforcement

Cozen O'Connor on

False Claims Act (FCA) enforcement has routinely targeted false information supplied to Medicare and Medicaid. A new trend in false-reporting cases is emerging under the FCA’s broad authority — cybersecurity enforcement....more

PilieroMazza PLLC

Settlements and Judgments from FCA and Fraud Matters Top $2.68 Billion in 2023

PilieroMazza PLLC on

On February 22, 2024, the Department of Justice (DOJ) released its annual statistical report (Annual Report) regarding settlements and judgments obtained in the False Claims Act (FCA) and fraud matters for Fiscal Year (FY)...more

Jackson Lewis P.C.

U.S. Supreme Court: False Claims Act Liability Depends on Defendant’s Subjective Beliefs

Jackson Lewis P.C. on

Liability in False Claims Act (FCA) suits depends on whether a defendant subjectively believed its claims were false, not on whether it can offer an objectively reasonable basis for its claims, the U.S. Supreme Court has held...more

McGuireWoods LLP

Supreme Court Clarifies the False Claims Act’s Knowledge Requirement, Eliminating a Potential Defense for Government Contractors...

McGuireWoods LLP on

On June 1, 2023, the Supreme Court unanimously ruled in favor of whistleblower plaintiffs (referred to as “relators”) in consolidated False Claims Act (“FCA”) cases in a decision that clarified the application of the FCA’s...more

Schwabe, Williamson & Wyatt PC

Supreme Court FCA Decision and NLRB GC Memo on Non-Competes

Two important decisions, one by the United States Supreme Court and one by the General Counsel for the National Labor Relations Board (“NLRB”), were issued this week and may be of interest to government contractors and...more

Goodwin

The Supreme Court Holds that the False Claims Act’s Scienter Element Turns on Defendant’s Subjective Beliefs, Rejecting Seventh...

Goodwin on

The Supreme Court recently issued a significant decision clarifying what it means to “knowingly” submit a false claim under the False Claims Act. At issue in United States ex rel. Schutte v. SuperValu Inc. were allegations...more

WilmerHale

High Court Hears Important Case on False Claims Act’s Scienter

WilmerHale on

On April 18, the Supreme Court heard oral argument and what has been billed as the most important False Claims Act (FCA) case in a decade. Since the FCA was enacted in the Civil War era, it has been the primary tool for the...more

Bass, Berry & Sims PLC

CMS Audits: Part 1 The ABCs of Medicare and Medicaid Claims Audits: Understanding the Audit Contractors

Bass, Berry & Sims PLC on

Because Medicare and Medicaid claims audit requests can look like routine billing-related correspondence, they can be easy to miss, leading to expensive and potentially catastrophic consequences. Providers, therefore, should...more

McCarter & English Blog: Government Contracts...

Knowing IS the Battle: Supreme Court to Address the FCA’s Scienter Standard

Scenario 1: A pharmacy chain hires a value consultant to review its Medicare and Medicaid billing practices for ways to optimize the coding of drug reimbursements to maximize profits. Drugs that had historically been charged...more

Dorsey & Whitney LLP

Eighth Circuit Analyzes Scope of FCA Liability Under Anti-Kickback Statute

Dorsey & Whitney LLP on

​​​​​​​On July 26, 2022, the Eighth Circuit Court of Appeals issued an opinion interpreting the standard for the causal link the government must show to establish that a “false or fraudulent” claim under the False Claims Act...more

Holland & Knight LLP

A Dizzying Map of Federal Vaccination Mandates, Injunctions and Stays

Holland & Knight LLP on

Keeping track of a dizzying number of injunctions and stays by multiple federal district courts and courts of appeal involving three separate federal COVID-19 vaccination mandates with a couple exceptions is no small task....more

Bradley Arant Boult Cummings LLP

Potential New Tennessee Law Prohibits Many Businesses from Requiring Proof of COVID-19 Vaccine, Requires Government Contractors to...

Things just got more complicated in Tennessee for private employers wrestling with COVID-19 vaccines. On October 30, the Tennessee Legislature passed an omnibus COVID-19 bill that does not entirely line up with the current or...more

Constangy, Brooks, Smith & Prophete, LLP

Texas Governor Issues "No-Mandate Mandate" On COVID-19 Vaccines

Oh, what a difference a few months makes. Yesterday, Texas Gov. Greg Abbott (R) issued Executive Order GA 40, which prohibits any entity in Texas, including private businesses, from requiring that employees or customers...more

Smith Anderson

The Biden Administration Puts the Burden on Employers

Smith Anderson on

On September 9, 2021, President Biden announced several updates to his plan for combatting the COVID-19 pandemic. Although media reports have led some to believe that President Biden’s actions have imposed an immediately...more

Schwabe, Williamson & Wyatt PC

Administration Actions Regarding COVID Protocols For Federal Contractors and Large Employers

On September 9, 2021, President Biden issued orders that have the intent of requiring employers to mandate that their employees are vaccinated against COVID-19 or undergo regular testing and other restrictions. ...more

Foley Hoag LLP - Medicaid and the Law

‘Objective Falsity’ and the FCA: An Ongoing Circuit Split

The False Claims Act (“FCA”) is a Federal statute originally enacted in 1863 as a response to fraud from defense contractors during the American Civil War. Under the FCA (31 U.S.C. §§ 3729 – 3733), it is a crime for any...more

Proskauer - Minding Your Business

Professional Relators Under False Claims Act Find No Friends in Federal Government or Seventh Circuit

Qui tam cases in American jurisprudence rely on a simple premise: help prevent nefarious actors from defrauding the government and Uncle Sam will compensate you for your efforts. With its roots in English law, the American...more

Sheppard Mullin Richter & Hampton LLP

Guard Against False Claims as Massive Government Spending Rolls Out to Combat COVID-19

Federal and state governments are ready to roll out over one trillion dollars in funding in response to the novel coronavirus (COVID-19) pandemic. As past is often prologue, we expect this new round of massive government...more

Bass, Berry & Sims PLC

Recent Developments in False Claims Act Pleading Standards

Bass, Berry & Sims PLC on

The Department of Justice (DOJ) recently released its report detailing the settlements and judgments obtained in 2019 from civil cases involving fraud and abuse claims. As in years past, the substantial majority of these...more

ArentFox Schiff

Investigations Newsletter: Defense Vehicle Manufacturer Accused of Defrauding the Government by $1.2 Billion

ArentFox Schiff on

Defense Vehicle Manufacturer Accused of Defrauding the Government by $1.2 Billion - On Tuesday, December 3, the United States District Court for the District of Columbia unsealed a six-year-old False Claims Act complaint...more

Foley Hoag LLP - Medicaid and the Law

Latest HHS Financial Report Highlights Medicaid Eligibility Errors – and Foreshadows Future Actions

On November 19, 2019, CMS announced key results from the 2019 HHS Agency Financial Report, which generally provides fiscal and high-level performance data for HHS for the reporting period of October 1, 2018 through September...more

Baker Donelson

False Claims Act Liability Without Submitting False Claims? Yes, That's a Thing

Baker Donelson on

Most health care providers recognize that submitting a knowingly false claim to a federally funded health care program violates the False Claims Act (FCA). However, it is less well known that indirectly "causing" someone else...more

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