The FCA’s implied certification theory is based on the concept that every time a payee submits a claim to the government it has impliedly certified compliance with all contractual, statutory, and regulatory obligations, and therefore, is entitled to payment. While the courts are currently divided on whether implied certification is a valid theory of liability, the courts that
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Fifth Circuit Provides Guidance on Who Has Standing to Pursue an FCA Retaliation Claim
In United States ex rel. Bias v. Tangipahoa Parish School Bd., — F.3d —-, 2016 WL 906227 (5th Cir. 2016), the Fifth Circuit provided guidance on the scope of individuals with standing to bring an FCA retaliation claim under 31 U.S.C. § 3730(h). In reversing the lower court’s dismissal, the circuit court explained that…
7th Circ. May Be Willing To End FCA Circuit Split
The False Claims Act’s “public disclosure bar” calls for dismissal of complaints by qui tam plaintiffs (or “relators”) whose allegations have already been publicly disclosed. The primary aim of the bar is preventing parasitic suits based on public information. Courts generally agree that disclosure to the government alone does not count as disclosure to the…
The Olympus Debacle: Why Internal Whistleblowing is a Good Thing for Compliance
The U.S. Department of Justice announced last week that Olympus Corporation of the Americas (OCA) agreed to pay $646 million to resolve three cases relating to its longstanding practice to bribe doctors and hospitals in the U.S. and abroad. The company entered deferred prosecution agreements (DPA) related to violations of the Anti-Kickback Statute (AKS) and…
Freddie Mac and Fannie Mae Not Considered Government Agents Under the FCA
In United States ex rel. Adams v. Aurora Loan Servs., Inc., 2016 WL 697771, — F.3d —- (9th Cir. Feb. 22, 2016), the Ninth Circuit found that Fannie Mae and Freddie Mac were not government entities for purposes of the False Claims Act. In so holding, the Ninth Circuit provided further clarity to the…
Whistleblower Denied Recovery In FCA Case With $322 Million Settlement
A whistleblower was recently denied any portion of the Government’s recovery in a False Claims case despite the Government obtaining a settlement of approximately $322 million. The decision arose in the case of United States ex rel. Swoben v. SCAN Health Plan, Case No. 09-cv-5013-JFW pending in the United States District Court for the Central…
Fifth Circuit Rejects FCA Case Based On Purported Improper Legal Billings
Although litigants frequently contend that the opposing party’s arguments are without factual or legal support, it is uncommon and unconventional for a litigant to contend that the opposing party has violated the FCA by advancing a purportedly weak legal argument. Despite the apparent oddity of such allegations forming the basis for an FCA claim, the…
Relator’s Allegations from Prior Lawsuit Serve as Basis for Public Disclosure Bar Dismissal
In United States ex rel. Wilhelm v. Molina Healthcare of Florida, No. 12-24298, 2015 WL 5562313 (S.D. Fla. Sept. 22, 2015), the court provided further clarification on two frequently litigated issues of the FCA’s public disclosure bar: (1) whether the date of filing or the date of the alleged FCA violation controls for determining which…
How Is a Relator’s Recovery in an FCA Settlement Taxed?
This rarely litigated question was presented to the Seventh Circuit in Patrick v. Commissioner of Internal Revenue, No. 14-2190, 2015 WL 5024985, — F.3d —- (Aug. 26, 2015). Previously, the First Circuit, in Fresenius Medical Care Holdings, Inc. v. United States, 763 F.3d 63, 71-72 (1st Cir. 2014), answered the related question of how an…
CMS Releases Data Regarding Hospital and Physician Utilization
CMS recently announced that it would be releasing Medicare hospital utilization and payment data, as well as physician and supplier utilization and payment data. This is the third year that the hospital data has been released and the second year that the physician data has been released.
Acting CMS Administrator Andy Slavitt explained that “[t]hese…