Articles and Blogs

On December 27, 2022, the Centers for Medicare & Medicaid Services (“CMS”) published a proposed rule that could potentially have a significant impact on enrollees’ obligations under the “60-day” overpayment rule. The original overpayment rule, which was signed into law in 2014 with the Affordable Care Act and expanded to Medicare Parts A and... READ MORE

The Second Circuit Court of Appeals emphasized, in affirming a district court’s ruling on a motion to dismiss, that a contract merely incorporating a statutory or regulatory payment provision by reference, without more, does not make all terms of the statutory and regulatory scheme material, express conditions of payment in False Claims Act cases.... READ MORE

Recently, Simon et al, v. Healthsouth of Sarasota Limited Partnership, et al, the Eleventh Circuit held that for a plaintiff to qualify as engaging in “protected activity,” the plaintiff must demonstrate that they had both a subjectively reasonable belief of fraud and an objectively reasonable belief of fraud. Background The plaintiff in this action... READ MORE

The Eleventh Circuit Court of Appeals recently affirmed that a qui tam relator’s original complaint, rather than any amended complaints subsequently filed in the action, is the “proper point of reference” for analysis under the False Claims Act’s (“FCA’s”) first-to-file rule. Cho on behalf of States v. Surgery Partners, Inc., No. 20-14109 WL 982126... READ MORE

Recently, the Seventh Circuit, in Proctor v. Safeway, Inc., clarified what it means to act with reckless disregard in respect to claims brought under the False Claims Act (“FCA”). ­__ F.4th ­__, No. 3:11-CV-3406, 2022 WL 1012256, (7th Cir. 2022). In doing so, the court stated that authoritative guidance must be truly authoritative in... READ MORE

A federal district court affirmed this guidance in a careful analysis of the attorney-client privilege and its application to protect separate legal entities within a larger corporate structure. Affirming that member entities are not treated as “one client,” the Court in U.S. ex rel Behnke v. CVS Caremark Corp., et al. denied a whistleblower’s... READ MORE

Earlier this week, the Department of Justice (“DOJ”) announced that the United States recovered over $5.6 billion from False Claims Act (“FCA”) cases in the federal fiscal year 2021, “the second largest annual total in False Claims Act history” and more than doubling the FCA recoveries for the DOJ from fiscal year 2020. Of... READ MORE

The Sixth Circuit Court of Appeals recently held that the statute of limitations period for retaliation claims under the False Claims Act (“FCA”) begins to run on the date of the alleged retaliatory event, and not the date the plaintiff discovers the retaliatory event. Case Background In 2008, the plaintiff physician joined a Michigan-based... READ MORE

In a recent opinion, the Seventh Circuit Court of Appeals adopted an interpretation of the False Claims Act’s “knowledge” requirement based on the Supreme Court’s interpretation of a similar provision under the Fair Credit Reporting Act. The Court’s application of this interpretation is good news for hospitals and health care systems that must regularly... READ MORE

The False Claims Act has long been a fierce, but fair weapon in the government’s fight against fraud. Recently, however, profit minded trial attorneys and private entities have monetized the FCA by taking advantage of the fraud statute’s ambiguous safeguards. By creating qui tam portfolios and securing stakes in whistleblower awards, these financially driven... READ MORE