News & Analysis as of

Relators Healthcare Fraud Whistleblowers

Bradley Arant Boult Cummings LLP

Eleventh Circuit Further Clarifies its “Reliable Indicia” Pleading Standard Under the False Claims Act

It has long been the law of the Eleventh Circuit that, under the False Claims Act (FCA) and Federal Rule of Civil Procedure 9(b), a relator must provide sufficient “indicia of reliability … to support the allegation of an...more

Robinson+Cole Health Law Diagnosis

First Circuit Makes Historic Decision: “But-For” Causation is the Majority Standard in AKS-Based FCA Claims

In a much-anticipated decision, the First Circuit unanimously ruled the government and relators must prove that a violation of the federal Anti-Kickback Statute (AKS) was the “but-for” cause of a false claim under the False...more

Health Care Compliance Association (HCCA)

Private-pay “crime stoppers”: Digesting the Corporate Whistleblower Awards Pilot Program

The U.S. Department of Justice’s (DOJ) Criminal Division launched its Corporate Whistleblower Awards Pilot Program (“Criminal Whistleblower Program”) in August of 2024 to encourage tips for various types of fraud, including...more

Pietragallo Gordon Alfano Bosick & Raspanti,...

Second Circuit Expands Anti-Kickback Statute Liability: “At Least One Purpose” is Enough

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

McCarter & English, LLP

Is the Qui Tam A Sham?: Federal Judge Finds Qui Tam Enforcement of False Claims Act Unconstitutional

McCarter & English, LLP on

A recent federal court decision has the potential to significantly impact the future of False Claims Act (FCA) lawsuits initiated by whistleblowers and to upend the FCA. In United States of America ex rel. Clarissa Zafirov v....more

Akerman LLP - Health Law Rx

Zafirov Decision Sets Stage for Appellate Showdown Over Constitutionality of FCA’s Qui Tam Provision

For the first time ever, a judge has ruled that the qui tam provision of the False Claims Act (FCA), which whistleblowers have used to recover $52 billion on behalf of the government since 1986, is unconstitutional....more

Wiley Rein LLP

Ding-Dong the Qui Tam Relator Is Dead? Novel FCA Decision Could Change How False Claims Are Prosecuted

Wiley Rein LLP on

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

PilieroMazza PLLC

Florida Federal Court Strikes Major Blow to FCA Whistleblowers: Key Takeaways for FCA Defendants

PilieroMazza PLLC on

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

Parker Poe Adams & Bernstein LLP

Florida Court Ruling on False Claim Act Deems Complaints By Private Whistleblowers as Unconstitutional

A valuable tool in filing whistleblower claims against companies related to government fraud took a potentially major hit this week when a federal judge in Florida ruled that a significant portion of the statutory scheme...more

Foley Hoag LLP - White Collar Law &...

District Court Declares FCA Qui Tam Provision Unconstitutional

On September 30, 2024, in U.S. ex rel. Zafirov v. Florida Medical Associates LLC, Judge Kathryn Mizelle in the Middle District of Florida dismissed a qui tam action under the False Claims Act (“FCA”) on the basis that the...more

Cozen O'Connor

Whistleblower Watch - A quarterly update on FCA Enforcement and Qui Tam Litigation - Winter 2024

Cozen O'Connor on

Whistleblower Watch is a comprehensive source for all False Claims Act (FCA) news and information. Every quarter, Cozen O’Connor will provide in-house counsel and compliance professionals with a summary of the most notable...more

Pietragallo Gordon Alfano Bosick & Raspanti,...

FY 2023 False Claims Act Recoveries: $2.67 Billion In Recoveries And Over $349 Million In Awards To Whistleblowers

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

American Conference Institute (ACI)

[Event] 11th Annual Advanced Forum on False Claims and Qui Tam Enforcement - January 23rd - 24th, New York, NY

Hosted by American Conference Institute, the 11th Annual Advanced Forum on False Claims and Qui Tam Enforcement returns for another exciting year for lively discussions on FCA enforcement including the ramifications of two...more

Cozen O'Connor

Big Data, Big Recovery: The Emergence of Data Analytics in Healthcare FCA Enforcement

Cozen O'Connor on

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

BakerHostetler

SCOTUS Majority Affirms the DOJ's Ability to Dismiss Whistleblower Cases Under the False Claims Act - But Dissent Raises Suspicion...

BakerHostetler on

On June 16, 2023, the United States Supreme Court issued an 8-1 decision in the case of United States, ex rel. Polansky v. Executive Health Resources, Inc., which held that the Department of Justice (DOJ) can move to dismiss...more

Akerman LLP - Health Law Rx

Mind Games: SCOTUS to Rule on what “Knowing” Means under the False Claims Act

What does it mean to “knowingly” or “recklessly” violate the law when that law consists of highly complex and ever-changing regulations, which may be open to interpretation? The U.S. Supreme Court recently agreed to review...more

Quarles & Brady LLP

Supreme Court to Review the Objective Scienter Standard Under the False Claims Act in U&C Drug Pricing Suits

Quarles & Brady LLP on

On January 13, 2023, the United States Supreme Court granted certiorari1 to review the False Claims Act (“FCA”) scienter standard in two FCA whistleblower cases from the Seventh Circuit, U.S. ex rel. Schutte v. SuperValu...more

Herbert Smith Freehills Kramer

Updates From ACI’s Advanced Forum on False Claims and Qui Tam Enforcement, June 22-23 in New York

Government, industry and outside counsel convened in New York June 22-23 at ACI’s Advanced Forum on False Claims and Qui Tam Enforcement to discuss recent trends in False Claims Act (FCA) case law and enforcement priorities....more

Bass, Berry & Sims PLC

False Claims Act Decisions and Settlements to Know from Q4 2021

The final months of 2021 saw a flurry of noteworthy False Claims Act (FCA) activity. Among other developments, appellate courts issued important decisions concerning materiality, the government’s qui tam dismissal authority,...more

Bradley Arant Boult Cummings LLP

Qui Tam Order Shows Concern Over FCA Plaintiffs' Leverage

Liability under the False Claims Act can result in potentially enormous payouts to individuals — and sometimes to companies — who alert the government to allegations of health care fraud. The payouts to the whistleblower...more

Akin Gump Strauss Hauer & Feld LLP

FCA Proposal Is Unfair And Would Hinder Economic Growth

As American industry moves toward building back better in the face of a continuing pandemic, Sens. Chuck Grassley, R-Iowa, and Patrick Leahy, D-Vt., have introduced the False Claims Amendments Act of 2021, proposing revisions...more

Pietragallo Gordon Alfano Bosick & Raspanti,...

The New Jersey False Claims Act: A Decade Of Data Reveal $147m Recovered By The Garden State

Takeaway: Based on data reported by the State Attorney General, New Jersey’s False Claims Act (NJFCA) has been a legislative success. Between 2010 and 2019, the State netted $147 million under the NJFCA, while relators...more

King & Spalding

Ninth Circuit Holds That Medical Opinions Do Not Automatically Preclude FCA Liability at the Pleading Stage

King & Spalding on

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

ArentFox Schiff

Deputy Associate Attorney General Sheds Light on DOJ’s FCA Priorities at Annual False Claims Act Conference

ArentFox Schiff on

“Enforcing the False Claims Act is a top priority for the Department—not just for our office,” said Deputy Associate Attorney General Stephen Cox, the Keynote Speaker for the 2020 Advanced Forum on False Claims and Qui Tam...more

ArentFox Schiff

Health Care Industry Remains in DOJ Fraud and Abuse Crosshairs

ArentFox Schiff on

The new numbers – published in DOJ’s annual False Claims Act recoveries statistics for Fiscal Year 2019 – brings FCA recoveries since FY 1987 (the year after Congress amended the FCA to incentivize whistleblowers further to...more

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