Topic Archives: False Claims Act

FCA
February 2, 2017False Claims Act

10 Key FCA Developments Of 2016

2016 was another active year in the land of False Claims Act enforcement. The U.S. Department of Justice continued to set recovery records and turned its eye more keenly on enforcement of individuals. We heard from the Supreme Court not once, but twice, on FCA issues. Per-claim penalties increased as of Aug. 1, opening the ...›

FCA
January 26, 2017Compliance, False Claims Act

FINAL FAR RULE: Prohibition on Reimbursement for Congressional Investigations and Inquiries

On January 13, 2017, the Department of Defense (“DoD”), General Services Administration (“GSA”), and National Aeronautics and Space Administration (“NASA”) issued a final rule, effective that day, that disallows costs incurred by a contractor in connection with a Congressional investigation or inquiry into an issue that is the subject matter of a proceeding resulting in ...›

FCA
November 29, 2016False Claims Act, Health Care

Tenet Case Signals Shift In Health Care Fraud Enforcement

Historically, the federal government has fought corporate healthcare fraud in two ways. First, the Department of Justice (“DOJ”) routinely intervenes in civil False Claims Act (“FCA”) cases filed by qui tam relators.  Second, the federal government typically has relied on individual U.S. Attorney’s Offices to initiate and prosecute criminal healthcare fraud cases.  Although DOJ relied ...›

FCA
November 28, 2016False Claims Act

Justices Should Stand Up for FCA Rules

The underlying facts of a False Claims Act case argued before the U.S. Supreme Court last week are the stuff of a good Hollywood blockbuster.  At the center of State Farm Fire and Casualty Co. v. U.S. ex rel. Rigsby are two sisters, Cori and Kerri Rigsby, who worked as claims adjusters for a company ...›

FCA
September 21, 2016False Claims Act

Courts Are Taking Materiality Seriously Post-Escobar

In the three months since the U.S. Supreme Court issued its decision in Universal Health Services v. United States ex rel. Escobar, lower court decisions suggest a trend of strict interpretation of the high court’s materiality requirement for False Claims Act allegations. Pleadings generally must allege facts demonstrating materiality to avoid dismissal. As a result, ...›

False Claims Act
August 23, 2016False Claims Act, Small Business

4 Steps For Avoiding FCA Traps For SBA Lenders

Recent U.S. Department of Justice enforcement and qui tam suits demonstrate that Small Business Administration lenders face increasing risk of liability under the False Claims Act. This article provides an overview of SBA programs, describes traps for potential liability, and highlights steps that SBA lenders can take to reduce FCA exposure. ...›

FCA
July 20, 2016False Claims Act

Aveta And The Use Of Confidential Info In FCA Cases

In a recent case in the District of Puerto Rico, United States ex rel. Valdez v. Aveta Inc., et al., No. 15-cv-01140-CCC (D.P.R.), the former president of Puerto Rican-based managed health care provider Aveta Inc., Jose Valdez, alleged that the health care company submitted as much as $350 million in false claims to the government through the Medicare Advantage program by manipulating risk adjustment scores. ...›

FCA
June 20, 2016False Claims Act

Universal Health: The Supreme Court Approves Implied Certification; Focus on Materiality Provides a Mixed Blessing to Defendants in False Claims Act Cases

On June 16, 2016, a unanimous Supreme Court blessed the implied false certification theory of False Claims Act (FCA) liability, resolving a circuit split on the theory’s legitimacy. The Court held that implied certification will succeed as a theory of liability where (1) the claim makes specific representations about the goods and services being provided and (2) the defendant’s failure to disclose noncompliance with material statutory, regulatory, or contractual requirements makes those misrepresentations misleading. ...›