Ninth Circuit Refuses to Kill Incentive Compensation Ban Whistleblower Suit

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Becker’s Hospital Review published Four Key Takeaways From 9th Circuit’s Resurrection of the Silingo Medicare Advantage Case, written by Constantine Cannon partner Jessica T. Moore. In the article, Ms. Moore analyzes the Ninth Circuit’s July, 2018, ruling in U.S. ex rel. Silingo v. WellPoint, Inc., a case brought by a whistleblower under the False Claims Act alleging risk adjustment fraud in Medicare’s Part C...
By Poppy Alexander
Top-level heart surgeons work in a rarified world, where few may question their medical judgment. Yet that judgment is not infallible-and its presence is not in itself a protection against False Claims Act liability. The Tenth Circuit recently held as much in United States ex rel. Polukoff v. St. Mark’s Hospital et al., finding that a doctor may be exercising medical judgment while still...
By Leah Judge
Reaffirming the importance of patient plans of care, the Sixth Circuit recently held that the timing of a physician’s certification of such plans is material to the government’s decision to pay for home health services. The case marks another circuit court’s application of the materiality standard announced in Universal Health Servs., Inc. v. United States ex rel. Escobar, and serves as a rebuke...
In Digital Realty Trust, Inc. v. Somers, a 9-0 opinion by Justice Ginsburg, the Supreme Court held that the anti-retaliation provisions of the 2010 Dodd-Frank Act do not extend to employees who have reported internally but extend only to employees who have reported suspected securities law violations to the SEC. The Supreme Court's decision reversed the Ninth Circuit, and resolved a longtime circuit split. The Fifth...
By the C|C Whistleblower Lawyer Team
Last Thursday, a judge in the Middle District of Florida threw out a $350M jury verdict against a nursing home provider. The basis of the decision was a stringent interpretation of the FCA’s materiality element. The ruling heavily relied upon the 2016 Supreme Court decision in Universal Health Services v. Escobar. This is the latest example of that ruling being hashed out in...
A recent district court decision from the Middle District of Tennessee serves as a reminder that qui tam relators would be wise to ferret out and include in their filings examples of any instances in which the government has taken enforcement action against companies involved in the type of misconduct they allege. It also underscores the point that courts must remember that the government has to pick and choose...