Relator Ronald Streck filed suit under the False Claims Act (FCA) asserting that Eli Lilly falsely under-reported its Average Manufacturer Price (AMP) for Medicaid by excluding “price increase values” (sometimes called...more
The Court unanimously held that a defendant’s subjective belief is relevant to scienter under the False Claims Act, even when a defendant’s conduct is consistent with an objectively reasonable interpretation of the law. ...more
The Situation: In March 2020, the Third and Ninth Circuits held, in two cases in which the government had declined to intervene, that a mere difference of medical opinion may be enough to satisfy the falsity element of the...more
The large volume of relief funding distributed by the government in connection with the COVID-19 pandemic will be the source of enforcement and regulatory scrutiny for years to come. During this webinar – the first in a...more
The question of whether the False Claims Act (FCA) requires a showing of objective falsity will continue to divide the circuit courts following the U.S. Supreme Court’s decision not to address the issue. To establish...more
The U.S. Supreme Court recently declined to address a circuit split regarding the standard for establishing that a statement material to a claim for payment is false under the False Claims Act (FCA); specifically, whether the...more
Supreme Court Declines to Review Issue of “Objective Falsity” Under False Claims Act - On February 22, 2021, the United States Supreme Court denied petitions for certiorari in a case that could have addressed the issue of...more
As our readers know, we have long been closely watching False Claims Act (FCA) cases across the country alleging the submission of false claims based on the lack of medical necessity, particularly as a possible circuit split...more
On February 22, 2021, the United States Supreme Court declined to review two False Claims Act (FCA) cases, solidifying a split that pits the Eleventh Circuit against the Third and Ninth Circuits as to whether a disagreement...more
In late March, the United States Court of Appeals for the Ninth Circuit revived a whistleblower lawsuit under the False Claims Act (FCA) in which a former employee accused a healthcare provider of submitting reimbursement...more
Last week, the United States Court of Appeals for the Third Circuit held that prognoses of terminal illness submitted in support of hospice claims for reimbursement could be actionable false statements under the False Claims...more
On March 4, 2020, the Third Circuit Court of Appeals held in United States ex rel. Druding v. Care Alternatives, No. 18-3298, 2020 U.S. App. LEXIS 6795 (3d Cir. Mar. 4, 2020) that a difference of opinion between a medical...more
The U.S. Department of Justice (DOJ) has reached a settlement with hospice company AseraCare, closing a 12-year-old saga that carries substantial implications for False Claims Act (FCA) enforcement in cases involving a...more
As many of our readers know, the AseraCare case was closely watched over the last several years because of its significance to efforts by the Department of Justice (DOJ) to allege that submission of claims for services...more
On September 9, in a setback for AseraCare but an overall win for hospice providers, the Eleventh Circuit affirmed a Northern District of Alabama decision to grant a new trial in a False Claims Act (FCA) case against...more
We are pleased to present Bradley’s annual review of significant False Claims Act (FCA) cases, developments, and trends. From a relatively short article several years ago, the Review has grown to a significant publication...more