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“Objective Falsity” Is Not Required Under the False Claims Act: A Legally False Opinion May Suffice

Posted 03/6/20

In a significant win for whistleblowers, a federal appellate court held this week that, in order to determine liability under the False Claims Act, a whistleblower need not prove that a claim is “objectively” false. Instead, the Court held that, consistent with common law, a claim can be false under the FCA if based not on objectively verifiable facts, but on non-compliance with statutory or regulatory...

Tagged in: Court Decision, FCA Federal, Home Health and Hospice, Importance of Whistleblowers, Medicaid, Medical Billing Fraud, Medicare, Whistleblower Case, Whistleblower Eligibility,

First Circuit Revives Whistleblower Suit Against PharMerica, Rejecting Public Disclosure Challenge

Posted 02/28/20

Rejecting an argument that only a fraudster could love, the First Circuit Court of Appeals revived a whistleblower’s lawsuit and rightly recognized that whistleblowers can have “direct” knowledge of fraud even if they did not themselves participate in the fraud. In United States ex rel. Banigan & Templin, et al. v. PharMerica, Inc., the First Circuit interpreted the so-called “original source” provision of...

Tagged in: Anti-Kickback and Stark, Court Decision, FCA Federal, Original Source, Pharma Fraud, Public Disclosure and Public Information, Whistleblower Case,

Treble Damages Awarded in Medicare Whistleblower Case

Posted 02/21/20

The Fifth Circuit upheld a 2018 lower court decision this week, finding defendant BestCare Laboratory Services, LLC and its owner Karim Maghareh liable for treble damages—to the tune of just over $30 million—under the False Claims Act. BestCare provided clinical testing services for nursing home residents, many of whom were Medicare beneficiaries. Rather than billing for a technician’s travel to and from the...

Tagged in: Court Decision, Defenses, FCA Federal, Importance of Whistleblowers, Laboratory and IDTF, Medical Billing Fraud, Medicare, Whistleblower Case,

Catch of the Week: Guardian Elder Care

Posted 02/21/20

This week's DOJ Catch of the Week goes to Guardian Elder Care. On Wednesday, the operator of more than 50 nursing homes in Pennsylvania, Ohio and West Virginia agreed to pay roughly $15.5 million to resolve allegations it violated the False Claims Act by billing the government -- Medicare and the Federal Employees Health Benefits Program -- for medically unnecessary rehabilitation therapy services. According to...

Tagged in: Catch of the Week, FCA Federal, Healthcare Fraud, Home Health and Hospice, Importance of Whistleblowers, Improper Medical Facility, Improper Medical Personnel, Medical Billing Fraud, Pharma Fraud, SNF, Whistleblower Case, Whistleblower Rewards,

Catch of the Week: Colorado Neurosurgeon and His Three Companies Settle Spinal Implant Kickback Claims for $2.35M

Posted 02/14/20

This edition of our Catch of the Week series features the successful resolution of a whistleblower suit against neurosurgeon Dr. William Choi and three companies he owned. The defendants agreed to pay the United States $2.35 million to resolve allegations that, for over five years, Dr. Choi received illegal kickbacks from spinal implant device distributors for devices he used in surgeries. The kickbacks rendered...

Tagged in: Anti-Kickback and Stark, Catch of the Week, FCA Federal, Medicaid, Medical Devices and DME, Medicare, Other Government Health Programs,

Time Limits Under The False Claims Act

Posted 02/14/20

fca whistleblower statute of limitations

If you have information about fraud, you may be able to bring a lawsuit on behalf of the government under the False Claims Act and receive a portion of any recovery. However, you should keep an eye on the clock. You have limited time to start your case before it could be barred by the False Claims Act’s statute of limitations or “first-to-file” rule.

What you should know about the False Claims Act Statute...

Tagged in: FCA Federal, Multiple Whistleblowers and First-to-File, Statute of Limitations, Whistleblower Answers,

Top Ten Whistleblower Developments of 2019

Posted 02/6/20

By any measure, 2019 was a Very Big Year for whistleblowers. Our annual Top Ten lists identified 2019’s most significant financial recoveries by whistleblowers, as well as recoveries in enforcement actions at the federal and state level involving government procurement, healthcare, financial, tax, and other types of fraud. But the numbers, as impressive as they are, can’t tell the full story of the impact that...

Tagged in: CFTC Whistleblower Reward Program, Cybersecurity and Data Breaches, FCA Federal, Government Procurement Fraud, Healthcare Fraud, Importance of Whistleblowers, International Whistleblowers, Risk Adjustment Fraud, SEC Whistleblower Reward Program, Top 10,

Opioid Executive Sentenced to Over Five Years in Prison for Role in Healthcare Fraud Scheme

Posted 01/31/20

Insys Therapeutics, an opioid manufacturer whose main product is Subsys, a spray from of fentanyl that is 100 times stronger than morphine and cost tens of thousands a month, is in the news again. The company and its former CEO, John Kapoor, have been facing a mountain of legal issues in the past three years. Last week, in a decision that most of our readers agree with, Kapoor was sentenced to 66 months in prison.

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, FCA Federal, Healthcare Fraud, Importance of Whistleblowers, Medicaid, Medicare, SEC Whistleblower Reward Program, Whistleblower Case, Whistleblower Rewards,

Catch of the Week: Practice Fusion Pays $145 Million for EHR Kickbacks and Misrepresentations about Software

Posted 01/28/20

Healthcare providers talk about the importance of behavioral “nudges” – gentle pushes to encourage healthy choices and positive behaviors. In our Catch of the Week, healthcare providers were nudged to prescribe highly addictive extended-release opioids in a manner that was not consistent with accepted medical standards. Who nudged them? Their own electronic health records system, which was paid to do so by the...

Tagged in: Anti-Kickback and Stark, Catch of the Week, Criminal Proceedings, Electronic Health Records, FCA Federal, Healthcare Fraud, Pharma Fraud,

Constantine Cannon Whistleblower Team’s Top-Ten “Staff Picks” of 2019

Posted 01/27/20

From cybersecurity, cryptocurrency, and “big data” to private-equity backed healthcare, private detention facilities, and the essential whistleblower experience – your prolific and relentless CC WB bloggers have chosen some of their favorite 2019 posts (and one from 2018) – don’t miss these insider-favorite gems!

1. Your worst nightmare – private data exposed to the unscrupulous – could be curbed...

Tagged in: Cryptocurrency, Cybersecurity and Data Breaches, FCA Federal, FCPA, Importance of Whistleblowers, Money Laundering, Pharma Fraud, Tax Fraud, Top 10, Whistleblower Case, Whistleblower Rewards,

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“Objective Falsity” Is Not Required Under the False Claims Act: A Legally False Opinion May Suffice

First Circuit Revives Whistleblower Suit Against PharMerica, Rejecting Public Disclosure Challenge

Treble Damages Awarded in Medicare Whistleblower Case

Catch of the Week: Guardian Elder Care

Catch of the Week: Colorado Neurosurgeon and His Three Companies Settle Spinal Implant Kickback Claims for $2.35M

Time Limits Under The False Claims Act

What you should know about the False Claims Act Statute...

Top Ten Whistleblower Developments of 2019

Opioid Executive Sentenced to Over Five Years in Prison for Role in Healthcare Fraud Scheme

Catch of the Week: Practice Fusion Pays $145 Million for EHR Kickbacks and Misrepresentations about Software

Constantine Cannon Whistleblower Team’s Top-Ten “Staff Picks” of 2019

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