News & Analysis as of

Relators Healthcare Fraud

Bradley Arant Boult Cummings LLP

Eleventh Circuit Further Clarifies its “Reliable Indicia” Pleading Standard Under the False Claims Act

It has long been the law of the Eleventh Circuit that, under the False Claims Act (FCA) and Federal Rule of Civil Procedure 9(b), a relator must provide sufficient “indicia of reliability … to support the allegation of an...more

McGuireWoods LLP

First Circuit Adopts “But For” AKS Standard, Leaving Third Circuit Alone in Causal-Link Standard

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On Feb. 18, 2025, the U.S. Court of Appeals for the First Circuit adopted the “but for” causality standard for violations of the federal Anti-Kickback Statute (AKS) that give rise to violations of the federal False Claims Act...more

Robinson+Cole Health Law Diagnosis

First Circuit Makes Historic Decision: “But-For” Causation is the Majority Standard in AKS-Based FCA Claims

In a much-anticipated decision, the First Circuit unanimously ruled the government and relators must prove that a violation of the federal Anti-Kickback Statute (AKS) was the “but-for” cause of a false claim under the False...more

Foley Hoag LLP - White Collar Law &...

False Claims Act in 2025: Looking Back and What’s Ahead

This is the fifth in our 2025 Year in Preview series examining important trends in white collar law and investigations in the coming year. We will be posting further installments in the series throughout the next several...more

Health Care Compliance Association (HCCA)

Private-pay “crime stoppers”: Digesting the Corporate Whistleblower Awards Pilot Program

The U.S. Department of Justice’s (DOJ) Criminal Division launched its Corporate Whistleblower Awards Pilot Program (“Criminal Whistleblower Program”) in August of 2024 to encourage tips for various types of fraud, including...more

Bass, Berry & Sims PLC

DOJ Releases Annual Civil Fraud Recovery Statistics and Results… Our Look Behind the Numbers

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On January 15, the Department of Justice (DOJ) released its annual report on civil fraud recoveries for FY2024 along with a press release highlighting DOJ’s civil enforcement efforts....more

Pietragallo Gordon Alfano Bosick & Raspanti,...

Second Circuit Expands Anti-Kickback Statute Liability: “At Least One Purpose” is Enough

In a significant ruling, the Second Circuit Court of Appeals recently expanded the scope of the Anti-Kickback Statute (AKS).The Court joined other circuit courts across the country in adopting, for the first time, the...more

Foley Hoag LLP - White Collar Law &...

Hospital Avoids Admissions in False Claims Act Settlement, While Repeat Relator and Government Cash in on Medical Necessity...

There was a noteworthy False Claims Act (FCA) settlement made public yesterday out of the Eastern District of California involving Oroville Hospital. The government accused the Hospital of submitting false claims to Medicare...more

Seyfarth Shaw LLP

Federal District Court Finds False Claims Act Qui Tam Provision Unconstitutional

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In a landmark decision, the United States District Court for the Middle District of Florida, in United States ex rel. Zafirov v. Florida Medical Associates, LLC, held that the False Claims Act’s (FCA) qui tam provision –...more

McCarter & English, LLP

Is the Qui Tam A Sham?: Federal Judge Finds Qui Tam Enforcement of False Claims Act Unconstitutional

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A recent federal court decision has the potential to significantly impact the future of False Claims Act (FCA) lawsuits initiated by whistleblowers and to upend the FCA. In United States of America ex rel. Clarissa Zafirov v....more

Akerman LLP - Health Law Rx

Zafirov Decision Sets Stage for Appellate Showdown Over Constitutionality of FCA’s Qui Tam Provision

For the first time ever, a judge has ruled that the qui tam provision of the False Claims Act (FCA), which whistleblowers have used to recover $52 billion on behalf of the government since 1986, is unconstitutional....more

Polsinelli

Supreme Court Declines to Hear “Willfulness” Case

Polsinelli on

On Monday, October 7, 2024, the U.S. Supreme Court declined to consider a petition for certiorari in United States ex rel. Hart v. McKesson Corp., Case No. 23-1293, where relator, Adam Hart (“Relator”), sought review of a...more

Wiley Rein LLP

Ding-Dong the Qui Tam Relator Is Dead? Novel FCA Decision Could Change How False Claims Are Prosecuted

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Years from now, might we cite a recent Middle District of Florida decision as the beginning of the end of the False Claim Act’s (FCA) qui tam provision in its current form? In granting the defendants’ motion for judgment on...more

Husch Blackwell LLP

Florida Federal Court Strikes Down False Claims Act Qui Tam Provisions as Unconstitutional

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A federal judge in Florida issued a ruling this week holding that the qui tam provisions of the False Claims Act (FCA) are unconstitutional. In the lawsuit, a relator named Clarissa Zafirov accused the defendants of violating...more

PilieroMazza PLLC

Florida Federal Court Strikes Major Blow to FCA Whistleblowers: Key Takeaways for FCA Defendants

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In a prior blog, PilieroMazza discussed the Supreme Court’s decision in United States ex rel. Polansky v. Executive Health Resources, Inc. In that case, in his dissenting opinion, Justice Clarence Thomas referred to the qui...more

Parker Poe Adams & Bernstein LLP

Florida Court Ruling on False Claim Act Deems Complaints By Private Whistleblowers as Unconstitutional

A valuable tool in filing whistleblower claims against companies related to government fraud took a potentially major hit this week when a federal judge in Florida ruled that a significant portion of the statutory scheme...more

Foley Hoag LLP - White Collar Law &...

District Court Declares FCA Qui Tam Provision Unconstitutional

On September 30, 2024, in U.S. ex rel. Zafirov v. Florida Medical Associates LLC, Judge Kathryn Mizelle in the Middle District of Florida dismissed a qui tam action under the False Claims Act (“FCA”) on the basis that the...more

Morgan Lewis

Second Circuit Confirms ‘Willfulness’ Standard for Scienter Has Teeth Under the Anti-Kickback Statute and False Claims Act

Morgan Lewis on

In a new decision that could have a significant impact on the persistent efforts of relators to reach otherwise lawful conduct and characterize it as a violation of the Anti-Kickback Statute (AKS), the US Court of Appeals for...more

Cozen O'Connor

Whistleblower Watch - A quarterly update on FCA Enforcement and Qui Tam Litigation - Winter 2024

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Whistleblower Watch is a comprehensive source for all False Claims Act (FCA) news and information. Every quarter, Cozen O’Connor will provide in-house counsel and compliance professionals with a summary of the most notable...more

Pietragallo Gordon Alfano Bosick & Raspanti,...

FY 2023 False Claims Act Recoveries: $2.67 Billion In Recoveries And Over $349 Million In Awards To Whistleblowers

On February 22, 2024, the Department of Justice (“DOJ”) published its annual review of cases and recoveries under the False Claims Act. Through the end of fiscal year 2023, total recoveries (across all years) under the False...more

Bass, Berry & Sims PLC

Second Circuit Rejects Insufficient Service-of-Process Argument, Adopts Relator-Friendly Rule

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On November 28, the U.S. Court of Appeals for the Second Circuit held that the service-of-process clock for a False Claims Act (FCA) qui tam complaint begins to run when the district court orders the complaint to be served,...more

American Conference Institute (ACI)

[Event] 11th Annual Advanced Forum on False Claims and Qui Tam Enforcement - January 23rd - 24th, New York, NY

Hosted by American Conference Institute, the 11th Annual Advanced Forum on False Claims and Qui Tam Enforcement returns for another exciting year for lively discussions on FCA enforcement including the ramifications of two...more

Bass, Berry & Sims PLC

False Claims Act Decisions to Know from Q2 2023

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In this post, we summarize noteworthy False Claims Act (FCA) decisions from the second quarter of 2023. U.S. Supreme Court Decisions. The second quarter was particularly noteworthy because the Supreme Court decided two...more

Cozen O'Connor

Big Data, Big Recovery: The Emergence of Data Analytics in Healthcare FCA Enforcement

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Law enforcement, federal agencies, and private whistleblowers are increasingly working alongside data scientists to identify fraudulent practices by analyzing vast data sets. The application of data analytics has notably...more

Zuckerman Spaeder LLP

The Supreme Court Confirms the Government’s Essentially Unfettered Authority to Dismiss False Claims Act Cases

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On Friday, June 16, 2023, I (sort of) lost my bet that the Supreme Court would follow the path charted in Borzilleri v. Bayer Healthcare Pharmaceuticals, 24 F.4th 32 (1st Cir. 2022) to determine the government’s False Claims...more

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