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On August 26, 2024, the United States Attorney’s Office for the District of Montana filed a False Claims Act (FCA) complaint against a Montana oncologist, alleging that the oncologist’s busy schedule led to excessive claims that violated the FCA. The complaint is unusual in that its chief theory is the amount of time the oncologist spent with patients, relative to what the Justice Department claims is the standard practice of other oncologists. In that respect, the complaint is a warning sign to busy physicians across the country.

This blog post begins by explaining how this Montana oncologist found himself on the Justice Department’s radar—a self-disclosure by the health system that previously employed the oncologist—before discussing what the Justice Department is alleging against the oncologist, as well as what other physicians should learn from this lawsuit.

Continue Reading DOJ False Claims Act Suit Against Montana Oncologist Is a Warning Sign to Busy Physicians
Supreme Court Sunrise

The Supreme Court issued a number of headline-grabbing decisions this term on topics like religious accommodation, LGBTQ protections, and consideration of race in college admissions. These decisions are wide-reaching and impact individuals, employers, and higher education institutions. Though not nearly as wide-reaching, the Supreme Court also issued two important decisions this year dealing with the False Claims Act (FCA) that could have dramatic impact nonetheless for those ensnared in an FCA action.

Continue Reading False Claims Act Update: A Mid-Year Review (2023)

On June 14, 2023, a federal jury found that a Georgia physician knowingly violated the False Claims Act following a two-week trial on allegations that he made false claims to the Medicare Program. Now, despite just $1.1 million in improper payments stemming from false claims, a federal court is likely to impose a judgment that exceeds $27 million after adding statutory per-claim penalties and trebling the amount determined by the jury to be false.

Continue Reading Georgia Physician Awaits $27+ Million Judgment Following False Claims Act Trial Loss

Cosmetic surgeries are on the rise. One study of cosmetic surgery data found that body procedures like tummy tucks, buttock augmentation, and liposuction increased by 63 percent from 2020 to 2021.[1] Facelifts were up 54 percent.[2] And breast procedures were up 48 percent.[3] According to that study, Americans spent over $14.6 billion on aesthetic procedures in 2021 with surgical revenues increasing by 63 percent.[4]

Continue Reading Justice Department Sues Iowa Surgeon Under False Claims Act for Masking Non-Covered Cosmetic Procedures as Covered Surgeries

On February 27, 2023, a jury in Minnesota federal court rendered a verdict in favor of the United States and against a surgical product distributor following a False Claims Act jury trial that lasted six weeks.[1] The jury identified $43 million in Medicare payments flowing from 64,575 kickback-procured claims.

Continue Reading Trial Lost, $400+ Million Liability Looming: Quick Takeaways From a Recent False Claims Act Jury Trial
Hospice Insights

Hospices and the False Claims Act Series

The False Claims Act (FCA) is the government’s most serious weapon to combat fraud in the healthcare community, and hospices are increasingly the target of FCA investigations and lawsuits. The United States Supreme Court is, for the first time, considering FCA cases involving hospices and certifications of terminal illness. Moreover, the relief funds disbursed by the government to hospices as a result of the COVID-19 pandemic add to the existing and substantial number of bases of potential FCA liability for hospices. Aggressive government investigation, enforcement efforts and increased whistleblower activity is coming. Hospices can and should prepare for this new environment. In this series, Meg Pekarske talks with Husch Blackwell attorneys Bryan Nowicki, Jody Rudman and Brian Flood about emerging issues involving hospices and the FCA. Bryan, Jody and Brian will share their experiences as seasoned litigators in FCA cases to help hospices understand the FCA trends affecting hospices, and provide practical guidance to help hospices prepare themselves to preempt, combat and successfully face FCA allegations.

Proposed Amendment Would Increase Liability Risk

The False Claims Act is a powerful enforcement tool used to go after those who defraud the government. Unfortunately, the wide net cast by the False Claims Act can lead to extremely negative consequences for upstanding hospices. In this episode we discuss a proposed amendment to the False Claims Act that would widen that net even further, and describe the mounting opposition to this legislation: https://bit.ly/3yEqq0b.

Hospice Insights

Success in False Claims Act Lawsuits

In this third episode of the Husch Blackwell Hospice Team’s “Hospice and the False Claims Act” series, Meg Pekarske, Bryan Nowicki, Jody Rudman and Brian Flood discuss the process and path of a False Claims Act (FCA) lawsuit. FCA cases are a test of endurance as much as they require expert marshalling of facts and law. The Hospice Team gives the insider’s view of an FCA lawsuit, including how hospices and their attorneys work together to identify strengths and weaknesses, manage expectations and develop a winning strategy. Tune in: https://bit.ly/3B78exg

The United States Department of Justice (“DOJ”) has intervened in a False Claims Act (“FCA”) case against a Florida compounding pharmacy, Diabetic Care Rx, LLC d/b/a Patient Care America (“PCA”), and, in an unexpected move, named PCA’s private equity sponsor and controlling shareholder, Riordan, Lewis & Haden, Inc. (“RLH”), as a co-defendant. The DOJ complaint accuses PCA, RLH and two PCA officers/directors (who were also RLH partners) of overseeing a kickback scheme which DOJ alleges induced referrals that resulted in TRICARE paying over $68 million for medically unnecessary compound drug prescriptions. DOJ alleges the illegal scheme was designed by RLH.

Continue Reading DOJ Adds Private Equity Firm to False Claims Act Complaint

In some courts in the United States today, a government contractor or a healthcare provider seeking reimbursement from a federal program can violate the False Claims Act even when its work is satisfactory and its invoices are correct. Under the theory of “implied certification,” a minor instance of non-compliance with one of the thousands of applicable statutes, regulations, and contract provisions can be the basis for a federal investigation, years of litigation, as well as fines, penalties, suspension and debarment, even imprisonment of company personnel. Continue Reading How the Supreme Court will limit False Claims Act liability for implied certification

The District of Columbia reached a settlement agreement with Children’s Hospital, Children’s National Medical Center Inc. and its affiliates (collectively, “CNMC”) on June 15, 2015, to resolve allegations that CNMC violated the False Claims Act by submitting false cost reports and other applications to the U.S. Department of Health & Human Services (“HHS”) as well as to the Virginia and District of Columbia Medicaid programs. Further details can be found in the Department of Justice’s press release announcing the settlement. Continue Reading Children’s hospital to pay $12.9 million to settle alleged False Claims Act violations