Posts Tagged ‘FCA’
The Federal Government Nets $2.2B in Settlements and Judgements Under the False Claims Act, Including $1.7B in Healthcare-Related Fraud
Settlements and judgements under the False Claims Act (FCA) surpassed $2.2 billion for the fiscal year ending Sept. 30, 2022. Of that, $1.7 billion related to matters involving the healthcare industry, including drug and medical device manufacturers, durable medical equipment, home health and managed care providers, hospitals, pharmacies, hospice organizations, and physicians. The government and…
Read MoreBilling Under Another’s Credentials Results in FCA Violation for Therapy Company
A Macon, Ga. rehab facility has been ordered to pay more than $9.6 million in damages after a district court judge ruled in favor of the government in a civil case alleging the fraudulent billing of hundreds of TRICARE and Medicaid claims. The order was the result of a judge’s recent ruling in which he…
Read MoreDrug Treatment Clinic Owner to Pay Settlement in FCA Whistleblower Lawsuit
At first glance, a recent settlement agreement by the owner and CEO of two Colorado-based behavioral health and substance abuse treatment clinics may not seem like a lot. However, it can serve as a reminder that the government is continuing its crackdown on those who take advantage of the ongoing opioid crisis. The case involves…
Read MoreFlorida-based Consultant Resolves FCA Allegations
Ted Albin and his firm, Grapevine Billing and Consulting Services Inc., recently agreed to pay $50,000 to settle allegations they violated the False Claims Act (FCA). It was alleged that between 2008 and 2017 Albin and Grapevine provided consulting services to the now-defunct Arriva, its parent company Alere Inc., and Abbott Laboratories, and that from…
Read MoreDOJ recovers $5.6B in FCA Settlements/Judgments
The U.S. Department of Justice (DOJ) recently announced it had taken in more than $5.6 billion in False Claims Act (FCA) settlements and judgments in the fiscal year ending Sept. 30, 2021. That’s the second largest annual total in the history of the FCA and the largest in seven years. In FY 2020, DOJ’s recoveries…
Read MoreProviders Beware: Ensure That Diagnostic Tests are Medically Necessary!
A fundamental principle of providing healthcare services to Medicare beneficiaries is that the services must be “medically necessary,†which means that they must be “reasonable and necessary for the diagnosis or treatment of illness or injury.†42 U.S.C. § 1395y(a)(1)(A). This requirement also imposes an obligation on healthcare providers to ensure that health services ordered…
Read MoreSCOTUS Declines to Review FCA Objective Falsity Standard
The United States Supreme Court recently declined to take up two cases relating to whether a False Claims Act can go forward if the only evidence proving medical necessity are conflicting medical opinions. The plaintiffs in both cases were hoping to settle the question since courts around the country have been split on the issue.…
Read MorePharma Giant Novartis Settles FCA Claims
Pharma giant Novartis has agreed to pay more than $642 million to resolve claims it violated the False Claims Act (FCA). The company also will forfeit $38.4 million under the Civil Asset Forfeiture Statute. In the first settlement, the company agreed to pay $51.25 million to settle allegations it illegally paid the copay obligations for…
Read MoreSCOTUS Hears Arguments on Implied Certification Theory
Last month, the United States Supreme Court took up the issue of whether False Claims Act (FCA) cases may be brought by whistleblowers and the government under the theory known as “implied certification.†And, if so, under what circumstances. On April 19, the high court heard oral arguments in Universal Health Services v. United States…
Read MoreSCOTUS to take on implied certification liability under FCA
The U.S. Supreme Court will decide whether False Claims Act (FCA) cases may be brought by whistleblowers and the government under the theory known as “implied certification†and if so, under what circumstances. Under this theory, when a provider submits a claim for government payment, it does so with the implication that it is being…
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