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
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
The U.S. Supreme Court’s decision in Ruan v. United States ups the ante for prosecutors who bring charges against doctors for unlawfully dispensing and distributing drugs under the Controlled Substances Act. Under the Supreme Court’s guidance, to secure a conviction, the government must now prove, beyond a reasonable doubt, that doctors knowingly and intentionally exceeded