OIG Removes Mandatory Cost-Sharing Obligations for COVID-19 Ambulance Transport Waiver
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Sixth Circuit Creates Circuit Split, Allows Former Employee’s FCA Retaliation Claim
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 Statute (AKS). While dismissing certain of the relator’s claims for failure to plead with the requisite particularity, the court allowed…
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 court found that the relator’s personal experience as a participant in the alleged billing scheme provided adequate indicia of reliability…
Stark Law 2020 Settlements Return to Pre-2019 Trend
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 voluntary submissions submitted several years ago mark an increase from 2019’s report when CMS announced the lowest aggregate settlement dollars collected since the Stark Law disclosure’s first year in 2011.…
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 and potential high costs that invoking this protection could mean for companies — particularly federal government contractors, see our post …
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 significant because it gives insight into how an appellate court will approach contested issues on appeal after a rare criminal…
U.S. Attorney’s Office Settles with Urgent Care Providers to Resolve False Claims Act Allegations Related to Credentialing Issues
On April 8, the U.S. Attorney’s Office for the District of South Carolina announced a $22.5 million settlement with a network of urgent care providers and its management company for alleged False Claims Act violations related to credentialing issues.
For more details about this settlement, which reminds healthcare providers that even where patient care is not compromised, a blatant pattern of record-keeping, licensing, certification, credentialing and other administrative errors can still lead to significant FCA…
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 the motion in United States v. Medcom Carolinas, Inc., No. 1:17-CV-34, 2021 WL 981240 (M.D.N.C. Mar. 16, 2021) was plaintiff’s…
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 falsity element.
Because of the conflicting appellate court decisions, healthcare providers and government contractors “need to be vigilant because depending…