In 2022, the government continued to utilize the False Claims Act as its primary tool to combat fraud. Though the government’s recoveries at $2.2 billion were down compared to recent years, the government and whistleblowers were party to more than 350 settlements and judgments – the second-highest number of FCA settlements and judgments in a
In what may lead to the biggest FCA opinion in recent history, the U.S. Supreme Court earlier this month agreed to consider two cases addressing the necessary state of mind (i.e., “scienter”) to violate the FCA.
The FCA prohibits defendants from knowingly submitting false claims. That scienter standard is broader than just actual knowledge.
The First Circuit gave defendant AthenaHealth something extra to celebrate this past holiday season when on December 21, 2022, in United States ex rel. Lovell v. AthenaHealth, Inc., it denied relators’ claims for over $1 million in attorneys’ fees in an appeal involving two issues of first impression.
AthenaHealth was a consolidated appeal involving
On December 6, 2022, the Supreme Court heard oral argument in United States ex rel. Polansky v. Executive Health Resources, Inc. As previously reported, this case raises whether the government has the authority to dismiss a False Claims Act (FCA) qui tam suit after it initially declined to proceed with its own action and
How much detail must a plaintiff allege to meet the heightened pleading standards that apply in an FCA case? Appellate courts have taken different approaches, but given a chance to address a seeming circuit split, the Supreme Court declined to clarify a standard.
On October 17, the Supreme Court denied the petitions for certiorari in
Continuing its focus on healthcare technology and electronic health records (EHR) companies, the Department of Justice announced last month a $45 million settlement to resolve a False Claims Act suit involving EHR provider Modernizing Medicine, Inc. (ModMed). The underlying complaint involved allegations in three areas that often draw government scrutiny — exclusive contracts, marketing agreements
As Medicare Advantage attracts more eligible beneficiaries, it is also drawing attention from False Claims Act (FCA) prosecutors. In 2022, enrollment in Medicare Advantage plans reached 28.7 million Medicare beneficiaries, or 49% of eligible beneficiaries. Recently, the United States intervened in a qui tam case against Cigna filed in the Southern District of New York and
Industry organizations in business, healthcare, pharmaceuticals, and medical technology filed amicus briefs this week in support of the False Claims Act (FCA) defendants in the Supreme Court case United States, ex rel. Polansky v. Executive Health Resources, Inc. As previously reported here, this case raises whether the government has the proper authority to dismiss
With some estimates as high as $80 billion, fraud within the Small Business Administration’s Paycheck Protection Program (PPP) has been described as the worst in a generation. The government has taken note with aggressive enforcement strategies across the country. Starting with what can be described as low-hanging fruit, the government’s enforcement efforts have expanded and
The Eighth Circuit split with the Third Circuit over the appropriate causation standard in False Claims Act (FCA) cases involving alleged violations of the Anti-Kickback Statute (AKS), holding that the 2010 amendments to the AKS created a “but-for causal requirement” (United States ex rel. Cairns v. D.S. Medical, LLC).
In 2010, Congress amended