False Claims Act Insights - Are the FCA’s Qui Tam Provisions Unconstitutional? One Federal Judge Says “Yes"
False Claims Act Insights - Assessing the Fallout from a Thermonuclear FCA Verdict
FCA Uncovered: Mitigating Risk in the Regulatory Spotlight — Regulatory Oversight Podcast
False Claims Act Insights - Think You Know Whistleblowers? Think Again.
Fraud and Abuse Enforcement Priorities in the Wake of COVID-19 - Diagnosing Health Care Podcast
On Feb. 18, 2025, the U.S. Court of Appeals for the First Circuit adopted the “but for” causality standard for violations of the federal Anti-Kickback Statute (AKS) that give rise to violations of the federal False Claims Act...more
On January 15, the Department of Justice (DOJ) released its annual report on civil fraud recoveries for FY2024 along with a press release highlighting DOJ’s civil enforcement efforts....more
In a significant ruling, the Second Circuit Court of Appeals recently expanded the scope of the Anti-Kickback Statute (AKS).The Court joined other circuit courts across the country in adopting, for the first time, the...more
Years from now, might we cite a recent Middle District of Florida decision as the beginning of the end of the False Claim Act’s (FCA) qui tam provision in its current form? In granting the defendants’ motion for judgment on...more
A federal judge in Florida issued a ruling this week holding that the qui tam provisions of the False Claims Act (FCA) are unconstitutional. In the lawsuit, a relator named Clarissa Zafirov accused the defendants of violating...more
In a prior blog, PilieroMazza discussed the Supreme Court’s decision in United States ex rel. Polansky v. Executive Health Resources, Inc. In that case, in his dissenting opinion, Justice Clarence Thomas referred to the qui...more
In a new decision that could have a significant impact on the persistent efforts of relators to reach otherwise lawful conduct and characterize it as a violation of the Anti-Kickback Statute (AKS), the US Court of Appeals for...more
On February 22, 2024, the Department of Justice (“DOJ”) published its annual review of cases and recoveries under the False Claims Act. Through the end of fiscal year 2023, total recoveries (across all years) under the False...more
Law enforcement, federal agencies, and private whistleblowers are increasingly working alongside data scientists to identify fraudulent practices by analyzing vast data sets. The application of data analytics has notably...more
United States ex rel. Polansky v. Executive Health Resources, Inc. (S. Ct. June 16, 2023) - The vast majority of False Claims Act cases are initiated by private parties, known as relators, not the government. In fact,...more
On Friday, June 16, 2023, the United States Supreme Court (SCOTUS or the Court) upheld prior decisions by the trial court and Third Circuit in U.S. ex rel. Polansky v. Executive Health Resources, Inc. Polansky involves the...more
The U.S. Supreme Court, in an 8-1 decision written by Justice Kagan, held on June 16 that the United States (“Government”), having initially chosen not to intervene in a False Claims Act (“FCA”) qui tam case, but having...more
The Department of Justice (DOJ) released its annual summary of False Claims Act (FCA) recoveries for the prior fiscal year, and the data points to a number of notable trends. Although DOJ brought in the second-highest...more
Takeaway: Over ten years, the Maryland False Health Claims Act has returned $160M to the State. This Digest summarizes each of the 173 matters reported under the Act from 2011 through 2021....more
Over the last decade, observers have noted that states have begun to play a greater role as regulatory enforcers – a trend that increased with the federal regulatory roll-back that began with the advent of the Trump...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
Through a January 9, 2020, press release, the Department of Justice (“DOJ”) reported more than $3 billion in total recoveries from settlements and judgments from fraud-related civil matters brought under the False Claims Act...more
• 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
In early August, the U.S. District Court for the Western District of Texas granted a hospital system’s motion to dismiss a False Claims Act case that illustrates the increasing intersections in FCA litigation between data...more
WHAT’S INSIDE - Who Decides How Bankruptcy Laws Are Applied? PROMESA: An Experiment Doomed to Fail - The Role of Alter Ego in Restructuring - SPECIAL FRAUD SECTION - Don’t Depend on a Handshake - Health...more
The Northern District of Illinois is the latest court to grant a defendant’s motion to dismiss in a False Claims Act (FCA) case, after the relator failed to meet the substantial pleading burden established in the U.S. Supreme...more
On February 11, 2019, the Eighth Circuit affirmed the dismissal of a group of relators’ qui tam suit against Crawford County Memorial Hospital for failure to meet the pleading standards required by Federal Rule of Civil...more
In 2018, the False Claims Act (“FCA”) continued to be one of the federal government’s (“Government”) preferred civil fraud enforcement tools across a variety of industries. The healthcare industry, however, remained the...more
The Delaware Supreme Court recently affirmed a decision by the Delaware Court of Chancery addressing a plaintiff’s ability to acquire key documents from a defendant company based on allegations against that company in an...more
On September 4, 2018, the Third Circuit revived a False Claims Act (FCA) suit against PharMerica Corporation that the District Court had dismissed based on the FCA’s public disclosure bar. ...more