Articles and Blogs

On February 22, 2024, the Department of Justice (“DOJ”) announced that it recovered over $2.68 billion in False Claims Act (“FCA”) settlements and judgments during the 2023 federal fiscal year. Notably, this amount stems from the highest number of settlements and judgments in a single year, including 543 settlements and judgments during this last... READ MORE

The United States District Court for the Eastern District of Wisconsin recently issued a decision involving protections for employees whose jobs involve the investigation of fraud. The case, brought under the anti-retaliation provision of the False Claims Act (“FCA”), is available here. Since 2009, the FCA’s anti-retaliation provision,(codified at 31 U.S.C. § 3730(h)(1)), has provided... READ MORE

The Ninth Circuit recently held in Hendrix ex rel. United States v. J-M Manufacturing Company, Inc. that in False Claims Act (“FCA”) cases, one penalty per project or FCA violation is proper, rather than one penalty per line item contained within the project or violation. Background In this case, the plaintiff brought suit against the... READ MORE

The Fourth Circuit recently held that providers may not defend a False Claims Act (“FCA”) lawsuit by arguing that eligibility requirements violate the Medicaid Act. Rather, liability under the FCA may still be established if any misrepresentations made by a provider influenced decision-makers and resulted in the submission of false claims to the government.... READ MORE

On June 16, 2023, the U.S. Supreme Court decided United States ex rel. Polansky v. Executive Health Resources, Inc. The Court’s opinion settles two outstanding questions about the authority of the Government to dismiss FCA actions in which it first declines to intervene but that whistleblowers continue to pursue on the Government’s behalf. First,... READ MORE

On June 1, 2023, the U.S. Supreme Court in U.S. ex rel. Schutte v. SuperValu, Inc. held that the mental state required by the False Claims Act (“FCA”) refers to the defendant’s actual knowledge and subjective beliefs about the truth of claims for payment submitted to federal payors. This decision overturns the growing body of... READ MORE

On February 7, 2023, the Department of Justice (“DOJ”) announced that it recovered over $2.2 billion in False Claims Act (“FCA”) related settlements and judgments in the federal fiscal year 2022. While this is less than half of the previous year’s recovery of $5.6 billion, the number of cases settled was the second highest... READ MORE

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