U s false claims act

Reasons to Watch: This case exemplifies the government’s continuing focus on HHA-related fraud schemes. The relators in this case alleged a large-scale conspiracy closely resembling past cases that the Medicare Fraud Strike Force (“Strike Force”) for the Eastern District of Michigan pursued and won. The government has focused its investigatory resources on large-scale investigations to get “more bang for the buck” and to maximize public visibility of health care fraud enforcement efforts. For instance, in the most recent “mega-takedown,” the Strike Force charged 90 individuals who were purportedly responsible for $260 million in false billings to federal health care programs.5 Seven of these 90 individuals were located in Detroit and were charged for their roles in fraud schemes involving approximately $30 million in false claims for medically unnecessary services, including home health services, psychotherapy, and infusion therapy. It is … [Read more...] about Health Care Law Qui Tam Update: Recent Developments & Unsealed False Claims Act Cases-October 2014

Summary of Case: Relator, in connection with his employment at a home health care agency, met with Dr. Malik about a referral for speech therapy services that had been made to the relator’s employer. During that meeting, Dr. Malik purportedly refused to sign a referral form, stating instead that the patient would be receiving services from Dr. Malik’s own agency. Relator was later informed that Dr. Malik would in fact sign off on the referral, and when the relator went to retrieve the signed form, he contends that he “noticed an absurdly large number of referral documents to Prime Care and no other.” When he commented on this, the relator was told that Dr. Malik sent all his patients to Prime Care because he and his brother owned it. Based on this interaction, the relator began his own research and investigation by asking health care professionals and patients about their knowledge of Dr. Malik and his agency. Relator alleged that Dr. Malik had either a direct … [Read more...] about Health Care Qui Tam Update: Recent Developments & Unsealed False Claims Act (FCA) Cases May 2014

On June 16, 2016, the United States Supreme Court issued a unanimous decision which held that an implied false certification made for the purpose of claiming payment from the government can serve as a basis for False Claims Act liability. The court held that when an individual or entity submits a claim to the government making specific representations about goods or services provided, but fails to disclose noncompliance with material statutory, regulatory or contractual requirements that result in those representations being misleading, that individual or entity may be subject to liability under the False Claims Act. … [Read more...] about U.S. Supreme Court Issues Important Decision Regarding False Claims Act Liability

Danon appealed that decision to the Third Circuit, arguing that his Dodd-Frank Act claim should be permitted to proceed based on recent precedent holding that the Dodd-Frank Act’s anti-retaliation protections extend beyond allegations that a whistleblower makes directly to the United States Securities and Exchange Commission (SEC). Danon further argued that his lawsuit was not barred because the state court had not fully ruled on the matter. The SEC provided support to Danon’s arguments on appeal, arguing in separate amicus briefs that individuals are entitled to anti-retaliation protections if they make any of the disclosures identified in Section 21F of the Securities Exchange Act (covering parts of the SEC’s whistleblower program), regardless of whether they separately report to the SEC. … [Read more...] about Dodd-Frank Act Claims, Non-SEC Whistleblowers, False Claims Act Appeal: Review of Recent Whistleblower Developments April 2017

2. SCOTUS to Hear a False Claims Act Case in 2016       On December 4, just after the DOJ announced its FY 2015 numbers, the Supreme Court decided to grant certiorari in a qui tam case to address the scope of "falsity" under the False Claims Act. In United States, ex rel Escobar v. United Health Services, Inc., 780 F.3d 504 (1st Cir 2015), the First Circuit Appellate Court reviewed the question of whether a false statement made with regard to participation in a government program, but not an express condition of payment, can be the basis for a false claim under the Act. Under the theory of "implied certification liability," a party may be held liable under the False Claims Act where that party made an otherwise proper request for payment, but failed to adhere to a statute, regulation, or contract provision that was a precondition to payment. The "implied" liability aspect relates to the fact that defendant has made no express certification of compliance when it … [Read more...] about Two Recent Announcements Regarding False Claims Act