On April 29, 2021, the U.S. Department of Health and Human Services Office of Inspector General issued a favorable advisory opinion offering first-time guidance on the development and investment of an ambulatory surgery center owned jointly by a hospital, management company and physician investors employed by the hospital.
OIG Removes Mandatory Cost-Sharing Obligations for COVID-19 Ambulance Transport Waiver
As previously discussed, on April 3, 2020, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) issued a process for inquiries to be submitted to OIG about whether administrative enforcement discretion would be provided for certain arrangements directly connected to the 2019 novel coronavirus (COVID-19). OIG established this process
Sixth Circuit Creates Circuit Split, Allows Former Employee’s FCA Retaliation Claim
The U.S. Court of Appeals for the Sixth Circuit held, in connection with an interlocutory appeal, that the False Claims Act (FCA) anti-retaliation provisions protect relators from post-employment retaliatory conduct. In United States ex rel. Felten v. William Beaumont Hosp., 993 F.3d 428 (6th Cir. 2021), the Sixth Circuit reversed the district court’s dismissal of
Texas Court Allows FCA Case to Proceed Based on Purchasing “Future Referrals”
In United States ex rel. Roshan v. E. Tex. Med. Ctr., 2020 U.S. Dist. LEXIS 252092, 2020 WL 8918651 (E.D. Tex. (Nov. 24, 2020)), a Texas federal court partially dismissed a relator’s claim alleging the defendants engaged in various billing and referral practices that violated the False Claims Act (FCA), the Stark Law, and Anti-Kickback
Alleged Emergency Room Advanced Professional Practitioner Billing Scheme FCA Case Proceeds
In U.S. ex rel. Sonyika v. ApolloMD, Inc. et al., 2021 WL 1222379 (N.D. Ga. Mar. 31, 2021), a Georgia federal court allowed a relator’s Amended Complaint alleging a fraudulent scheme involving improper billing for services rendered by Advanced Professional Practitioners (APP) in violation of the False Claims Act (FCA) and the Georgia-equivalent to proceed. The
Stark Law 2020 Settlements Return to Pre-2019 Trend
RELATED UPDATE: CMS Streamlines Stark Law Self-Disclosures (March 8, 2023)
The Centers for Medicare & Medicaid Services (CMS) recently announced 2020 settlements concerning past violation or potential violations of the physician self-referral law (the Stark Law) and the number and value of such settlements have returned to the pre‑2019 trends. The 2020 settlements based on
The Perils of Pleading the Fifth in the Corporate Fraud Context
“Pleading the Fifth” is one of the most commonly known phrases in the U.S. legal system, and the right against self-incrimination is one of the Constitution’s most meaningful protections. That said, the costs and risks of exercising that right in the corporate fraud context may outweigh the benefits.
To learn about some of the limits
Sixth Circuit Affirms Jury Criminal Conviction in Federal Healthcare Kickback Scheme
In a recent opinion from the United States Court of Appeals for the Sixth Circuit, the court analyzed several alleged points of error from a criminal jury trial about a healthcare kickback scheme. See United States v. Trumbo, No. 20-1393, __ F. App’x __, 2021 WL 957337 (6th Cir. March 15, 2021). The opinion is
Request to File Amended Complaint for Fraud Rejected for Failure to Allege Facts with Particularity
After granting defendants’ motion to dismiss and dismissing plaintiff’s action with prejudice, the U.S. District Court for the Middle District of North Carolina recently denied relator’s motion to alter or amend the judgment and file an amended complaint alleging Anti-Kickback Statute (“AKS”) and False Claims Act (“FCA”) violations. Central to the court’s decision to deny
Michael Podberesky Discusses Circuit Split on FCA’s False Statement Standard
In an April 7, 2021, interview with Federal News Network, Washington, D.C., partner Michael Podberesky discussed how federal contractors are impacted by the U.S. Supreme Court’s recent decisions denying two petitions for writs of certiorari, thereby declining to resolve a circuit court split regarding the False Claims Act’s standard for pleading and proving the