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The first Lady-Justice-150x150False Claims Act decision regarding the “60-day rule” created by the Affordable Care Act (ACA), was recently decided by the United States District Court for the Southern District of New York. The Department of Justice (DOJ) intervened in the False Claims Act (FCA) lawsuit which was pursued by whistleblower Robert Kane against his former employer Healthfirst MCO. The DOJ alleges that Healthfirst committed fraud against the government when they attempted to retain over $1 million dollars in overpayments made by Medicare and Medicaid to the healthcare provider. In U.S. ex rel Kane v. Healthfirst, Inc., NO. 11-2325 (S.D.N.Y), the district court denied Healthfirst’s motion to dismiss and clarified what constituted “identification” under the “60-day rule”.    Continue reading ›

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Govt-Health-Insurance-Policy-150x150 2The first settlement involving a healthcare provider’s failure to investigate credit balances on its books has been reached. The Pediatric Services of America (PSA) has settled with the US government and several US states for $6.88 million to resolve all False Claims Act allegations made against the company. PSA, based in Norcross, Georgia, provides home nursing services to medically fragile children. Two whistleblowers, who had previously worked for the facility, came forward with extensive information demonstrating that PSA was knowingly being overpaid by the government and was not returning the excess funds. The case alleged that PSA violated federal and state law, affecting both the federal government and seventeen states. Continue reading ›

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BU009443In a far ranging decision, the Ninth Circuit held that whistleblowers need only meet two requirements to be considered an “original source” under the False Claims Act (FCA). First, the whistleblower must inform the government of the alleged fraud voluntarily. Second, the whistleblower must have “direct and independent knowledge” of the alleged fraud. The courts restatement of the original source requirement means that whistleblowers who have participated in the public disclosure of fraud are not automatically barred from bringing a FCA suit. This decision reversed the district court’s earlier ruling in United States ex rel. Hartpence v. Kinetic Concepts, Inc., which had dismissed the plaintiffs claim under the public disclosure bar. In a less surprising ruling, the Ninth Circuit also held that the district court erred when finding that the plaintiff would have also been dismissed under the first to file bar. Continue reading ›

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Whistle 2Education Affiliates (EA) was involved in a lawsuit for violating the False Claims Act (FCA) according to the US Department of Justice (DOJ). Five whistleblowers came forward with information regarding the for-profit education company, stating that EA was submitting false information to the Department of Education to receive federal student aid for students enrolled in its programs. The DOJ recently reached a settlement with EA for $13 million. The whistleblowers, who brought the case under the qui tam provisions of the FCA, will each receive a percentage of the whistleblower’s share of $1.8 million. The whistleblowers who came forward with this information helped the government prevent further fraudulent billing by EA. Continue reading ›

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Talking-to-Patient-300x186The Department of Justice (DOJ) has recently resolved a case involving the largest settlement of alleged violations of the Anti-Kickback Statute by a skilled nursing facilities company in the United States. The skilled nursing company, Plaza Health Network, and its former president and executive director have agreed to pay $17 million to resolve allegations that the company violated the False Claims Act (FCA) by submitting claims to Medicare and Medicaid for patients that were referred to the company through illegal kickbacks. The whistleblower, who brought the case under the qui tam provisions of the FCA, will receive $4.25 million as his share of the recovery. Continue reading ›

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This weeYellow-and-Red-Pills-150x150k the US Court of Appeals for the Fourth Circuit affirmed a South Carolina District Court judgment against Tuomey Healthcare System. The damages and penalties against Tuomey totaled $237,454,195 as decided in United States ex rel. Drakeford v. Tuomey Health Care System, Inc. A jury had found the defendant liable under the False Claims Act for their reporting of false claims to Medicare. The decision ends a case which has been under litigation for nearly ten years. Continue reading ›

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Stethoscope 2AstraZeneca and Cephalon have both reached settlements with the US Department of Justice (DOJ), totaling $54 million. AstraZeneca has agreed to pay the United States and participating states a total of $46.5 million with interest. Cephalon, which is now owned by Teva, has agreed to pay the United States and participating states a total of $7.5 million. The companies were accused of deliberately underreporting Average Manufacturer Prices (AMPs) to public health programs. The cases were brought by a whistleblower, Ronald J. Streck, under the qui tam provisions of the False Claims Act. Continue reading ›

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VMware aHedge-Fund-Manager-Holding-Moneynd Carahsoft Technology Corp. reached a settlement of $75.5 million with the General Services Administration (GSA) on Tuesday, June 30. This settlement resolves allegations made by a former Vice President at VMware that the companies violated the False Claims Act (FCA). The whistleblower alleged that the cloud service providers overcharged the federal government for software products and related services from 2007 through 2013. Although VMware still asserts that the allegations are false, they have agreed to pay the settlement money in order to put an end to the lawsuit. Continue reading ›

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Toviaz-Off-Label-PromotionIn the largest False Claims Act settlement in which the government did not intervene, DaVita Healthcare Partners has come to an agreement to pay the government $450 million. The false claims lawsuit involved DaVita’s largest division, DaVita Kidney Care. The division was accused of intentionally wasting medicine in order to defraud federal healthcare programs out of millions of dollars. This settlement concludes the false claims act cases that DaVita has defended in the past years, paying out nearly $1 billion to settle the three whistleblower lawsuits. Continue reading ›

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Supreme-Court-Pillars-150x150 3The Sixth Circuit has held that a construction contractor’s violation of the Davis-Bacon Act can also create liability under the False Claims Act (FCA). U.S District Judge Kevin H. Sharp issued a judgment ordering Circle C Construction, LLC to pay the United States a total of $762,894 for violation of the FCA. These Davis-Bacon Act and FCA violations were connected to Circle C’s construction project on the Fort Campbell military base. Continue reading ›

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