FCA NOW

DOJ Settles “First of its Kind” FCA Suit Involving Retention of Overpayments

Sydney Crowder

On August 3, the Department of Justice announced the first False Claims Act settlement of a case involving a health-care provider’s alleged failure to investigate, identify and refund overpayments from government programs, including Medicare, Medicaid and TRICARE.  Such claims (and settlements) may become more common given the recent amendments to the FCA in 2010, which provide that Medicare and Medicaid overpayments be reported and returned within “60...

Court Concludes that Violation of a Corporate Integrity Agreement May Form the Basis for Reverse False Claim Liability

David Couillard

In late July, a federal district court in Pennsylvania denied a motion to dismiss brought by pharmaceutical company Cephalon, Inc., concluding that violations of a corporate integrity agreement (“CIA”) entered into by Cephalon and the federal government could give rise to “reverse false claim” liability.  United States ex rel. Boise v. Cephalon, Inc., No. 2:08-cv-00287-TON (E.D. Pa. July 21, 2015). Conduct prohibited under section 3729(a)(1)(G)...

Fourth Circuit Affirms $237 Million Jury Verdict for Stark and FCA Violations; Rejects Advice-of-Counsel Defense

Andrew Brantingham

On July 2, the U.S. Court of Appeals for the Fourth Circuit affirmed a jury verdict of more than $237 million against Tuomey Healthcare System, a nonprofit hospital in South Carolina, based on Stark Law and False Claims Act violations.  United States ex rel. Drakeford v. Tuomey Healthcare System, No. 13-2219 (4th Cir. July 2, 2015).  The Government’s claims in the case were based on...

Ninth Circuit Concludes that Conviction Precludes Relator Recovery

Benjamin Greenberg

The Ninth Circuit last week held that pursuant to 31 U.S.C. 3730(d)(3) of the False Claims Act (“FCA”), a qui tam relator who is convicted of conduct giving rise to the fraud that is the subject of the FCA lawsuit must be dismissed from the lawsuit and is not entitled to a share in any recovery, even if the relator played only a minor role...

D.C. Circuit Determines that Physical Possession of Medicare Records Not Required in Implied-Certification Claim Against the District of Columbia

Benjamin Greenberg

On Friday, the U.S. Court of Appeals for the District of Columbia Circuit reversed a district court’s grant of summary judgment in favor of a relator based on the district court’s finding of a violation of the False Claims Act.  United States ex rel. Davis v. District of Columbia, No. 14-7060 (D.C. Cir. July 10, 2015). The relator’s FCA theory–implied-certification liability–relied on his allegation that...

Dialysis Provider Settles Whistleblower Lawsuit for $450 Million

Katherine Arnold

The Department of Justice and dialysis provider DaVita Healthcare Partners recently finalized a $450 million agreement settling claims that the company intentionally inflated Medicare billings.  The parties had filed a joint motion to stay the case, United States ex rel. et al. v. DaVita Inc., No. 07-02509 (N.D. Ga. Apr. 16, 2015), in April in order to focus on reaching a settlement. Relators Alon Vainer...

Ninth Circuit Unanimously Overrules Long-Standing “Original Source” Precedent; Makes it Easier to Qualify as an Original Source Under the FCA

Alex Hontos

For 23 years, the Ninth Circuit required that a relator establish three elements to qualify as an “original source” under the False Claims Act: (1) the relator must have direct and independent knowledge of the information on which her allegations are based; (2) the relator must have voluntarily provided that information to the government before filing her qui tam lawsuit; and (3) the relator must...

Seventh Circuit Rejects Implied Certification Theory of FCA Liability

Beth Forsythe

Deepening a circuit split, the Seventh Circuit has joined the Fifth Circuit in rejecting the implied false certification theory of liability under the FCA.  United States v. Sanford-Brown, Ltd., No. 14-2506 (7th Cir., June 8, 2015).  The Fourth, Ninth, Tenth and District of Columbia Circuits have allowed implied false certification claims. The implied false certification theory holds that when an entity enters into an agreement...

D.C. Circuit Interprets the First-to-File Rule Narrowly

Jake Vandelist

A decision this week from the D.C. Circuit shed light on three important issues.  United States ex rel. Heath v. AT&T, Inc., No. 14-7094 (D.C. Cir. June 23, 2015).  In 2008, the appellant, Todd Heath, filed an FCA qui tam suit against Wisconsin Bell, Inc., a wholly owned subsidiary of AT&T.  In that suit Heath alleged that certain employees of Wisconsin Bell made affirmative misrepresentations...

In KBR v. Carter, Supreme Court Clarifies the First-To-File Doctrine and the Statute of Limitations Under the Wartime Suspension of Limitations Act

Mike Rowe

Late last month, the Supreme Court issued a unanimous, two-part decision that clarified the meaning of the term “offense” as used in the Wartime Suspension of Limitations Act (“WSLA”), and the term “pending” as used in the first-to-file doctrine.  The Court held that (i) the suspension of the statute of limitations under the WSLA applies only to criminal offenses; and (ii) a qui tam suit...