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AseraCare Trial Set To Move To Phase Two

By on Oct 19, 2015
Posted In Knowledge/Scienter, Sampling/Extrapolation

The first round is over in U.S. ex rel. Paradies v. AseraCare, Inc., the False Claims Act (FCA) case pending in the U.S. District Court for the Northern District of Alabama that, as we previously reported, was the first in which a court bifurcated an FCA trial between the elements of falsity and scienter. The jury considered...

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Fourth Circuit to Rule on Use of Statistical Sampling to Prove FCA Liability

By on Oct 6, 2015
Posted In Sampling/Extrapolation

The U.S. Court of Appeals for the Fourth Circuit has agreed to hear an interlocutory appeal on the use of statistical sampling as a means of proving liability under the False Claims Act (FCA). While statistical methods of proof have been used with respect to damages, relatively few courts have considered whether such methods are...

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Adventist Health System Settles Stark Law & FCA Matters

By on Sep 23, 2015
Posted In Anti-Kickback Statute / Stark Law, Stark

Adventist Health System (Adventist) entered into a settlement agreement with the United States and with the states of Florida and North Carolina on September 21, 2015, resolving Stark Law issues that Adventist disclosed regarding a certain physician employment compensation model and certain other financial arrangements.  The settlement agreements also fully resolve the allegations in two...

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Central District of California Opinion Confirms that Information Gained through Employment is Not Necessarily “Direct” Knowledge under the Public Disclosure Bar

By on Sep 4, 2015
Posted In Knowledge/Scienter, Public Disclosure Bar

Last week, a court dismissed a relator’s claim for a share of the government’s $322 million settlement in United States v. Scan Health Plan, 2:09-cv-05013-JFW (C.D. Cal. Aug. 28, 2015), ruling that the relator did not qualify as an original source under the False Claims Act’s (FCA) public disclosure bar. The ruling followed the Court’s earlier...

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Recent Fifth Circuit Decision Spotlights Perils of Complex Procedural Issues

By on Sep 1, 2015
Posted In Public Disclosure Bar

On August 25, 2015, the Fifth Circuit vacated and remanded a district court’s order denying a relator’s Rule 60(b) motion for relief from dismissal based upon new evidence in the False Claims Act (FCA) case of United States ex rel. Gage v. Davis S.R. Aviation, LLC, No. 15-50141 (on appeal from Case No. 1:12-cv-00904-SS in...

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When an FCA Case Just Won’t Go Away: Attorneys’ Fees Remain Contested Even After Settlement

By on Aug 10, 2015
Posted In Attorney's Fees, Public Disclosure Bar

When settling a False Claims Act (FCA) case, the issue of a relator’s attorneys’ fees seems small compared to the monetary settlement and the breadth of the release. Two recent cases, however, demonstrate that fees can prove a sticking point in wrapping up an FCA case even after settlement. In U.S. ex. rel. Simring v....

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Ninth Circuit Overturns Precedent to Simplify Original Source Exception to Public Disclosure Bar

By on Jul 8, 2015
Posted In Public Disclosure Bar

Overruling its 23-year precedent, the Ninth Circuit, sitting en banc, held that to avoid dismissal under the False Claims Act’s (FCA) public disclosure bar, relators need not have participated in the public disclosure of alleged fraud to qualify as an “original source.” Although the court’s decision concerned the pre-2010 version of that bar, it is...

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Eastern District of Texas Awards Relator $218 Million Despite Fifth Circuit Caution That Claims Not Likely Material or Based on False Certifications

By on Jun 19, 2015
Posted In Attorney's Fees, Damages and Penalties

The Eastern District of Texas confirmed a jury verdict holding highway-guardrail manufacturer Trinity Industries liable for False Claims Act violations on June 9, 2015, resulting in a judgment of over $680 million against the company.  Out of the $663 million in damages and penalties, the court awarded the relator a 30 percent share of the...

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Recent Central District of California Opinion Confirms that Adding Fraud Allegation Is Insufficient to Overcome Public Disclosure Bar

By on Jun 8, 2015
Posted In Uncategorized

In a decision last week in United States v. Scan Health Plan, 2:09-cv-05013-JFW (C.D. Cal. June 1, 2015), the United States District Court for the Central District of California ruled that a State of California Controller’s Office (SCO) audit concluding that Scan Health Plan “appeared to be receiving duplicative or overlapping payments” from Medicare and...

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CMS Appears Receptive to Senators’ Requests to Change Focus of RAC Program to Providers with High Claims Denials

By on May 26, 2015
Posted In Uncategorized

Last Thursday, in a hearing before the Senate Special Committee on Aging exploring the relationship between Recovery Audit Contractor (RAC) audits and an increase in claims for hospital observation stays, a bipartisan duo of senators urged the Centers for Medicare & Medicaid Services (CMS) to shift the focus of RAC audits to providers that have...

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