News & Analysis as of

Medicare Settlement Appeals

Perkins Coie

First Circuit Imposes Higher “But-for” Causation Standard for False Claims Act Liability Based on Alleged Anti-Kickback Statute...

Perkins Coie on

On February 18, 2025, the U.S. Court of Appeals for the First Circuit added its voice to a growing chorus of appellate courts to elevate the standard of proof required to show a violation of the federal False Claims Act in...more

Husch Blackwell LLP

Are the qui tam provisions of the False Claims Act unconstitutional?

Husch Blackwell LLP on

The qui tam provisions of the False Claims Act allow individuals to file suit on behalf of the United States and to receive a share of the resulting financial settlement or judgment. Filing a qui tam case is not just a formal...more

ArentFox Schiff

Investigations Newsletter: Federal Government Urges Court of Appeals to Uphold Constitutionality of FCA Qui Tam Provisions

ArentFox Schiff on

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

ArentFox Schiff

Investigation Newsletter: Teva Pharmaceuticals Agrees to Pay $450 Million to Resolve FCA Claims

ArentFox Schiff on

Teva Pharmaceuticals Agrees to Pay $450 Million to Resolve FCA Claims - On October 10, the US Department of Justice (DOJ) announced that Teva Pharmaceuticals USA Inc. and Teva Neuroscience Inc. will pay $450 million to...more

McDermott Will & Schulte

Federal Jury Returns $43 Million Verdict for Kickback Scheme in Violation of the False Claims Act

After a rare False Claims Act (FCA) trial—especially one premised on violations of the Anti-Kickback Statute (AKS)—a federal jury in Minnesota returned a $43 million verdict against Precision Lens, a distributor of medical...more

Mintz - Health Care Viewpoints

False Claims Act Settlements and Judgments Exceed $5.6 Billion in Fiscal Year 2021

The Department of Justice announced in a February 1, 2022 press release (Press Release) that it obtained more than $5.6 billion in settlements and judgments from civil cases involving fraud and false claims in the fiscal year...more

Health Care Compliance Association (HCCA)

Provider Wins $2M Appeal at ALJ Over Modifier 25, Random Sample

Report on Medicare Compliance 30, no. 11 (March 22, 2021) - A cancer center has won its appeal of $2 million in Medicare claim denials in a case about modifier 25 and the extrapolation of an overpayment. Problems with the...more

Health Care Compliance Association (HCCA)

Report on Medicare Compliance Volume 29, Number 30. News Briefs: August 2020

Report on Medicare Compliance 29, no. 30 (August 24, 2020) - A federal court on Aug. 17 blocked HHS from enforcing its revised definition of sex discrimination in Sec. 1557, which prohibits discrimination on the basis of...more

Holland & Knight LLP

AseraCare Announces Settlement of Landmark False Claims Act Case for $1 Million

Holland & Knight LLP on

After litigation spanning more than a decade, hospice provider AseraCare announced its $1 million settlement with the U.S. Department of Justice (DOJ) in a closely-watched False Claims Act (FCA) case in the U.S. District...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

Hogan Lovells

False Claims Act Alert: Fourth Circuit Punts on Sampling and Extrapolation

Hogan Lovells on

Tuesday, the Fourth Circuit Court of Appeals ruled in the interlocutory appeal in United States ex rel. Michaels v. Agape Senior Community, Inc.. In an opinion considering two significant questions arising under the qui tam...more

Baker Donelson

It Ain't Over 'Till It's Over – First Circuit Rejects Settlement Agreements Between Providers and Intermediary and Upholds Cost...

Baker Donelson on

On October 27, 2016, a three-judge panel for the United States Court of Appeals for the First Circuit issued an opinion concluding that a Medicare fiscal intermediary (Intermediary) does not have the authority to enter into a...more

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