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False Claims Act Statistics, News & Analysis

  • 04
  • May
  • 2018

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Halfway to the Finish Line for FY2018

Fiscal Year 2018 is just over halfway through and by our count the government has recovered just over $1.1 billion dollars through April 2018. This year so far is consistent with last year, which clocked in at $1.2 billion by April 2017, but lags far behind FY16, which at this point had pulled down a hefty $3.8 billion already. Careful readers may recall that the FY16 numbers are a bit skewed by the single $1.2 billion Wells Fargo settlement, which landed on April 8, 2016. Yet even without Wells Fargo, FY16 remains the undisputed leader of recent years, and the DOJ of 2018 will have to do some serious sprinting if they want to catch up to the team of two years ago.

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Escobar The Sequel? — Perhaps Coming Soon to SCOTUS

On April 16, 2018, the Supreme Court called for the views of the Solicitor General (or “CVSG”) as to whether it should review the Ninth Circuit’s decision in Gilead Sciences, Inc. v. United States ex rel. Campie (that we at LLB believe was wrongly decided and have covered previously). The CVSG may indicate the Court’s willingness to provide much-needed clarification to Escobar’s materiality standard.

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Risky Business: Reverse FCA Allegations Against Medicare Advantage Insurer Survive

In an early mixed valentine for both the government and a defendant Medicare Advantage Plan insurer, a district court in California on February 12 denied a motion to dismiss reverse FCA claims alleging the failure to correct known invalid diagnosis codes submitted for risk adjustment payments to Medicare. The court did dismiss, however, the government’s claims that the insurer’s false statements as to the validity of the diagnosis codes also violated the FCA. Poehling v. Unitedhealth Group, Inc., No. 2:16-cv-08697 (C.D. Cal. Feb. 12, 2018).

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  • 22
  • November
  • 2017

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DOJ Heads for the Hills after Judge Rips FCA Case as a "House of Cards"

On October 27, 2017, Magistrate Judge Theresa Carroll Buchanan in the Eastern District of Virginia gave the government a brutal reality check on the viability of its case in United States of America ex rel. Ribik v. HCR ManorCare Inc., et al. when she plainly informed them at a hearing on defendants’ motion for sanctions: “I don’t think this case should have ever been brought.” DOJ has responded to this reproof by filing a motion to voluntarily dismiss the entire case with prejudice.

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  • 14
  • November
  • 2017

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Too Good To Be True? DOJ Teases Policy Shift to Dismiss Meritless Qui Tams

With good excuse, we at LLB are a bit late to the party on this bit of news. It appears that Michael Granston, the director of the DOJ Commercial Litigation Branch, Fraud Section — the office charged with guardianship of the FCA for all of DOJ — chose a health care compliance conference to announce what could be a major shift in enforcement policy. In an October 30 speech, which appears to have been covered only by RAC Monitor in the first instance, Granston announced that going forward, DOJ will move to dismiss cases it finds to be meritless, rather than permitting relators to litigate on their own.

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  • 03
  • November
  • 2017

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Frighteningly Large Settlement for Hospice Provider Whose Patients Lived

The day before Halloween, the DOJ announced that Chemed Corporation and its various subsidiaries have agreed to a $75 million settlement for submitting allegedly false hospice services claims to Medicare for reimbursement. Touting this as “the largest amount ever recovered under the False Claims Act from a provider of hospice services,” the government sets the tone early in the new fiscal year for a high-recovery agenda.

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