News & Analysis as of October 12, 2024

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The Anti-Kickback Statute is a United States federal criminal statute that prohibits the exchange (or the promise to exchange) of anything of value for referrals of federal healthcare program business. The statute aims to prevent situations where government officials channel federal healthcare dollars towards particular providers, who have offered or given the official a personal benefit. Penalties for violation of the Anti-Kickback statute apply to both sides of a prohibited transaction and can include jail time and steep monetary fines. less -

Now is Not the Time to Relax: Record Settlements in Stark Law and False Claims Cases

Lathrop GPM on 6/4/2024

In early May 2024, the University of Pittsburgh Medical Center (UPMC) agreed to pay $38 million to resolve a False Claims Act case based on alleged Stark Law violations. The size of the settlement in United States ex rel. J....more

U.S. Supreme Court Declines to Clarify Key Provisions of the False Claims and Anti-kickback Statutes

Stevens & Lee on 10/10/2023

Last week, the U.S. Supreme Court denied the request of qui tam relators that it review the Sixth Circuit’s recent decision in United States of America ex rel. Martin v. Hathaway, No. 22-1463 (6th Cir.). In so doing, the...more

False Claims Act Update: A Mid-Year Review (2023)

Husch Blackwell LLP on 7/7/2023

The Supreme Court issued a number of headline-grabbing decisions this term on topics like religious accommodation, LGBTQ protections, and consideration of race in college admissions. These decisions are wide-reaching and...more

A Sight for Sore Eyes: Sixth Circuit Rejects Government’s Expansive AKS and FCA Theories in Ophthalmologist Dispute

Bradley Arant Boult Cummings LLP on 4/5/2023

This week, the Sixth Circuit closed two paths the government and relators have tried to take to expand liability for medical providers under the Anti-Kickback Statute (AKS) and False Claims Act (FCA): the meaning of...more

Digest Of Maryland False Health Claims Act Recoveries: 2011‒2021

Pietragallo Gordon Alfano Bosick & Raspanti,... on 4/28/2022

Takeaway: Over ten years, the Maryland False Health Claims Act has returned $160M to the State. This Digest summarizes each of the 173 matters reported under the Act from 2011 through 2021....more

Court Dismisses FCA Retaliation Complaint Involving Speaker Fees

McGuireWoods LLP on 4/13/2021

In U.S. ex rel. Manieri v. Avanir Pharmaceuticals, Inc., 2021 WL 857102 (N.D. Oh. Mar. 8, 2021), the Northern District of Ohio dismissed a relator’s claim that he had been improperly retaliated because he had raised concerns...more

West Virginia Hospital Enters into a $50 Million Settlement to Resolve Allegations over Excessive Compensation Paid to Referring...

Mintz - Health Care Viewpoints on 9/16/2020

On September 9, 2020, the Department of Justice (DOJ) announced a $50 million settlement with Wheeling Hospital, Inc. of West Virginia to resolve False Claims Act allegations that Wheeling Hospital violated the Anti-Kickback...more

Escobar in Action: Physician-owners’ fraud claims against hospital defeated in Fifth Circuit appeal for lack of materiality

Dorsey & Whitney LLP on 12/11/2019

Following the passage of the Affordable Care Act (“ACA”), which placed new limits on physician-owned hospitals, St. Luke’s Health System (“System”) took action to change one of its hospital’s ownership structures through a...more

Remuneration? Not If It’s Fair Market Value, Says Eleventh Circuit

McDermott Will & Emery on 9/18/2019

Bingham v. HCA, Inc., a recent Eleventh Circuit case, highlights the centrality of fair market value to Anti-Kickback Statute (AKS) analyses. This decision is significant for several reasons and we expect to see Bingham cited...more

Health Care Qui Tam Update

Mintz on 11/9/2018

In this issue, we provide an overview of 62 recently unsealed qui tam cases and take an in-depth look at four of those cases. Two of the featured cases concern alleged schemes to provide unnecessary therapy to residents of...more

Eleventh Circuit Weighs In On FCA’s Alternate Remedies Provision

McGuireWoods LLP on 11/9/2018

Due to the infrequency in which the situation arises, the FCA’s “alternate remedy” provision is infrequently invoked or discussed. In short, this provision states that when the relator presents information about a potential...more

Healthcare Fraud & Abuse Review 2017

Bass, Berry & Sims PLC on 3/13/2018

A LOOK BACK... A LOOK AHEAD - While the uncertainty associated with legislative efforts to repeal the Patient Protection and Affordable Care Act (PPACA) dominated most of the headlines for the healthcare industry last year,...more

Third Circuit Rejects False Claims Act Theory that Anti-Kickback Violations "Taint" All Related Claims

Jones Day on 2/1/2018

The Situation: A provision in the False Claims Act ("FCA") had clarified when Anti-Kickback Statute ("AKS") violations can make a claim false, but the provision's rule of per se falsity does not answer when a claim "result[s]...more

Court Puts the Brakes on Whistleblower's FCA Parking Claims

Baker Donelson on 6/19/2017

The Department of Justice (DOJ) reports that, in fiscal year 2016 ending September 30, it obtained more than $4.7 billion in settlements and judgments from civil cases involving fraud and false claims. More than half of this...more

FCA Issues to Watch: FCA Claims Concerning Physician Compensation

Bass, Berry & Sims PLC on 5/5/2017

Physician employment arrangements with hospitals have remained a significant area of regulatory scrutiny in recent months with the announcement of several high profile settlements and decisions in key FCA cases involving...more

Healthcare Fraud and Abuse Review 2016

Bass, Berry & Sims PLC on 4/13/2017

Bass, Berry & Sims is pleased to announce the release of its fifth annual Healthcare Fraud and Abuse Review 2016. The Review, compiled by the firm’s Healthcare Fraud Task Force, is an industry-leading guide to healthcare...more

Justice Department Charges Pharma President with Kickback Conspiracy

The Volkov Law Group on 11/4/2015

In the public relations battle following the issuance of the Yates Memo, the Justice Department can now cite one example for the new policy – the recent arrest and charging of Carl Reichel, former President of Warner...more

Mintz Levin Health Care Qui Tam Update: Recent Developments & Unsealed Cases - September 2015

Mintz - Health Care Viewpoints on 9/22/2015

Trends & Analysis - Since our last Qui Tam Update, we have identified 39 health-related False Claims Act (“FCA”) qui tam cases that have been unsealed. Of those cases...more

Mintz Levin Health Care Qui Tam Update - Recent Developments and Unsealed Cases

Mintz - Health Care Viewpoints on 8/20/2013

Trends and Analysis: ..We have identified 20 health care-related qui tam cases unsealed in July 2013. About a quarter of those were filed in 2013. ..Among the cases unsealed in July, the government has declined to...more

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