On Tuesday, the United States filed an Amicus Curiae Brief on a closely watched petition for certiorari.  The Department of Justice articulated the government’s view of the proper standard for pleading fraud in a False Claims Act case.  The petition in United States ex rel. Nathan v. Takeda Pharms. N. Am. asked the Court to

In U.S. ex rel. Fair Laboratory Practices Associates v. Quest Diagnostic, Inc., the Second Circuit upheld the dismissal of a health care fraud qui tam action because of ethical violations by one of the relators, who was formerly general counsel of defendant Unilab Corporation.

The former general counsel, along with two other former employees

In U.S. ex rel. Wolfson v. Park Avenue Medical Associates, the U.S. Attorney’s Office in the Southern District of New York entered into a $1 million False Claims Act settlement against three related companies for improperly billing Medicare for behavioral health services.  The settlement agreement provided that the defendants “admit, acknowledge and accept responsibility

Earlier this month, a bill to amend the False Claims Act (“FCA”), the “Fairness in Health Care Claims, Guidance and Investigations Act,” was introduced in the House of Representatives.  According to one of the bill’s sponsors, Rep. Howard Coble (R-NC), the bill’s purpose is to ensure that unintentional billing disputes are not penalized as

Earlier this week, the Department of Justice announced that it had recovered nearly $5 billion in settlements and judgments under the False Claims Act in fiscal year 2012.  The $4.959 billion figure was a new record for a single year, eclipsing the previous one-year record by $1.7 billion.

In breaking down the $5 billion in

In late October the U.S. Attorney’s Office in the Southern District of New York announced the settlement of a False Claims Act case against Westchester Medical Center (“WMC”) for $7 million, for submitting false reimbursement claims to Medicaid from August 2001 through June 2010 involving outpatient behavioral health services.  The settlement is to be

Several health care industry companies, including Medicis, ArthroCare and Amedisys, reported in their 2012 first quarter reports that they were under Department of Justice investigations and had received civil investigative demands from the government.

Civil investigative demands, referred to as CIDs, are a particularly powerful pre-lawsuit administrative tool for federal investigations.  Using CIDs, the government

The U.S. Attorney’s Office for the Southern District of New York recently announced the settlement of a health care False Claims Act case against Beth Israel Medical Center for fraudulently inflating its fees for services provided to Medicare patients in order to obtain larger “outlier payments.”  Beth Israel agreed to pay over $13 million to

The 2010 Patient Protection and Affordable Care Act (“PPACA”) imposed an obligation upon Medicare providers, including physicians, hospitals, nursing homes and home health agencies, to report and return any overpayments they receive within 60 days of identification of the overpayment.  Failure to do so could result in substantial penalties to the provider under the False