News & Analysis as of

Whistleblowers Health Insurance False Claims Act (FCA)

ArentFox Schiff

Investigations Newsletter: DOJ Launches Corporate Whistleblower Awards Pilot Program

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DOJ Launches Corporate Whistleblower Awards Pilot Program - On August 1, the US Department of Justice (DOJ) announced the details of its new Corporate Whistleblower Awards Pilot Program. According to the DOJ, the...more

Dentons

DOJ Reports Record False Claims Act Settlements & Judgments in FY 2023

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Fiscal year 2023 saw record recoveries and the highest number of settlements and judgments ever under the Federal False Claims Act. According to a new report released by the United States Department of Justice (“DOJ”), the...more

Robinson+Cole Health Law Diagnosis

Home Health Company and Two Corporate Officers Settle False Claims Act Allegations for Over $30 Million

On October 18, 2022, the Department of Justice (DOJ) announced two settlements with CHC Holdings, LLC, an Oklahoma limited liability company doing business as Carter Healthcare (Carter), and two former senior corporate...more

Patrick Malone & Associates P.C. | DC Injury...

Waste, fraud, and abuse? For health insurers, fat profits matter more

What happens when a whistle blower provides detailed information about a burly Texan — with convictions for felony theft and felony injury of a child — and a burgeoning scam to rip off health insurers for $25 million? Pretty...more

Carlton Fields

Court Finds No Coverage for $42 Million False Claims Act Suit Due To Late Reporting

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A federal court has found no coverage for a $42 million whistleblower settlement due to the insured’s failure to timely report the claim to its carrier. PAMC, Ltd. v. National Union Fire Insurance Company of Pittsburgh, Pa.,...more

Holland & Knight LLP

EMTALA as a Basis for a Qui Tam Case?

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The Emergency Medical Treatment & Labor Act (EMTALA) requires a hospital with an emergency department (ED) to provide "an appropriate medical screening examination" when an individual comes to the ED and a request is made on...more

Farrell Fritz, P.C.

Medicaid Fraud Whistleblower Loses Bid To Keep His Name Out Of The Public Eye

Farrell Fritz, P.C. on

False Claims Act whistleblowers expose themselves to significant risks by coming forward and asserting claims of fraud against the government. Often, the whistleblowers, called relators under the False Claims Act, would...more

Troutman Pepper

Federal Court Strikes DOJ's Risk Adjustment False Claims Act Case - For Now

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On October 5, a federal district court in California dealt a significant setback to the government’s efforts to extend False Claims Act (FCA) liability to Medicare risk adjustment submissions....more

Bass, Berry & Sims PLC

Dismissal of Medicare Advantage FCA Suit Marks Significant Defeat for Government

Bass, Berry & Sims PLC on

The U.S. District Court for the Central District of California recently dismissed a complaint-in-intervention filed by the U.S. Department of Justice (DOJ) in U.S. ex rel. Swoben v. Secure Horizons. As previously reported,...more

Sheppard Mullin Richter & Hampton LLP

Alert: In a Surprise Decision Issued on October 5, 2017, Honorable John Walter, United States District Judge, Dismissed a Medicare...

On October 5, 2017, the Honorable Judge John Walter of the United States District Court, Central District of California, granted the Defendants’ Motion to Dismiss the Medicare Advantage (“MA”) Federal False Claims Act (“FCA”)...more

Polsinelli

Millennium Health to Pay $256 million in False Claims Act Settlement

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Millennium Health, one of the nation’s largest urine drug testing laboratories, has agreed to pay the government $256 million to resolve claims that it violated the Federal False Claims Act (“FCA”). The Settlement...more

Manatt, Phelps & Phillips, LLP

Health Update - September 2015

Latest Healthcare False Claims Act Roundup and Top 3 Best Practices to Reduce Exposure - As the legal landscape in healthcare becomes increasingly complex, healthcare companies that receive federal program funds face...more

Carlton Fields

Kane v. Healthfirst and the 60-day Repayment Rule

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Case: Kane v.Healthfirst, Inc. et al. and U.S. v. Continuum Health Partners Inc. et al., case number1:11-cv-02325, in the U.S. District Court for the Southern District of New York. As part of the Affordable Care Act...more

Obermayer Rebmann Maxwell & Hippel LLP

News from the Health Law Gurus™: July 2014

Survey of ACA Navigators Finds 10.6 Million People Sought Enrollment Help — In a survey released this week, the Kaiser Family Foundation (“Kaiser”) estimates that approximately 10.6 million people received assistance...more

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