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False Claims Act Archives

PA Doctors Motion for Summary Judgment after Third Circuit Ruling

The False Claims Act ("FCA") requires a materiality to establish a claim for liability, and defines "material" as a natural tendency or capability to influence a bribe. Earlier this year, the Third Circuit applied a stricter materiality standard in United States ex rel. Petratos v. Genentech Inc. ("Petratos"), 855 F.3d 481 (3d Cir. 2017). The Third Circuit ruled that plaintiffs failed to show that the defendant's alleged noncompliance with the Food and Drug Act ("FDA") regulations had an impact on the government's payment decisions, and thus, the alleged conduct was not materially noncompliant. The Court noted that, after the plaintiffs disclosed the defendant's alleged "campaign of disinformation" toward the FDA, the FDA still maintained its approval of the defendant's drug, Avastin, which was at the center of the dispute. Additionally, the government did not stop reimbursement payments for prescriptions of the drug.

FCA Suit Against HealthMarkets Dismissed

U.S. District Judge Mary S. Scriven dismissed a suit brought against HealthMarkets Inc. ("HealthMarkets" or the "Company") by an anonymous whistleblower ("John Doe" or "Doe") on May 23, 2017, after the federal government declined to intervene and John Doe dropped the suit.

Anham Fights Against False Claims Allegations

In 2014, Anham FZCO ("Anham"), a United Arab Emirates-based food supply contractor for the U.S. military in Afghanistan, was accused of misleading the government about the construction of a warehouse and its transportation of goods through Iran. Anham currently holds an $8.1 billion vendor contract with the U.S. Department of Defense ("DOD"). One of Anham's competitors, Supreme Foodservice CmbH ("Supreme"), which had previously held that contract but was convicted of defrauding the government in 2014, brought forth claims that Anham also violated the False Claims Act ("FCA").

Allergan Kickback Claims Survive Provisional Stage

John Wood ("Wood") served as a senior territory manager for Allergan Inc. ("Allergan" or the "Company") from October 2008 through July 2010, during which time he became privy to the allegedly illegal practice of bribing physicians to prescribe Allergan drugs in exchange for $100 million worth of drug samples and other goods. Once Wood internally reported the purported misconduct to Allergan, his was terminated. Consequently, Wood brought a False Claims Act ("FCA") lawsuit on behalf of the federal government and 25 states.

TeamHealth Settles $60M to End FCA Suit

Trillions of dollars are paid out every year through government programs. With this much money passing hands, it can be difficult to track where all this money goes, which can provide the opportunity for fraud. Laws like the False Claims Act ("FCA") and the Whistleblower Protection Act ("WPA") were implemented to help protect the government and prevent and prosecute fraud. The FCA enables the government to prosecute individuals or organizations that have committed fraud, and the WPA protects employees from retaliation for uncovering and disclosing illegal behavior within an organization. The WPA also provides substantial compensation for those willing to bring forth evidence of fraud.

FCA Sampling Case Left Undetermined

In September 2015, the Fourth Circuit agreed to hear the United States ex rel. Michaels v. Agape Senior Community, Inc., cv-15-2147, case in which Agape Senior Community, Inc. ("Agape") allegedly improperly billed Medicare and Medicaid for certain hospice services, thereby violating the False Claims Act ("FCA"). When oral arguments were held on October 26, 2016, the Fourth Circuit was unlikely to determine whether statistical sampling can provide evidence of FCA liability, which has been a decision many lower courts hoped would offer guidance.

Former American Senior Communities' Executives Indicted

Two former executives of the nursing home chain, American Senior Communities ("ASC" or the "Company"), James Burkhart ("Burkhart") and Daniel Benson ("Benson"), are facing charges for defrauding Medicare, Medicaid, and their own company. The two former executives were having vendors overcharge the company for services, some of which the government paid for, and had vendors pay the excess funds to them directly, equating to an estimated $16 million in overcharges. Both men face charges for conspiracy to commit mail, wire and health care fraud, mail or wire fraud, money laundering, and conspiracy to violate the Anti-Kickback Statute.

Pennsylvania Hospital Settles FCA Case on Overbilling Government Healthcare Programs

The Lehigh Valley Health Network ("Health Network") has reached an agreement to pay nearly $700,000 to the federal government to settle a qui tam lawsuit alleging that it violated the False Claims Act by overbilling multiple federal healthcare programs. Hospitals and treatment centers within Health Network were allegedly misrepresenting the medical services provided to patients, and billing programs such as Medicare, Federal Employees Health Benefits, and Workers' Compensation in excess of reimbursement policy allowances.

Atrium Medical Corp. Settles False Claims Act Allegations for $11.5 Million

In March 2013, Esther Grace Sullivan, a sales representative and territory business manager at Atrium Medical Corp. ("Atrium" or the "Company"), alleged that the Company was paying doctors to use its iCast stents for unapproved uses, a violation of the False Claims Act ("FCA"). Medical stents are used to stop arteries from re-closing and Atrium's stents were approved to treat tracheobronchial obstructions, but doctors have used them for other vascular system purposes. The FCA claims against Atrium involved providing doctors dinners, giving them grants, and offering other kickbacks in order to incentivize them to use Atrium's medical stents. Although the government is typically involved in FCA cases, since these cases involve defrauding the government and cheating it out of large sums of money, the government was not interested in being part of the lawsuit. Nonetheless, the Plaintiff moved forward with her claims.

Home Care Co. Pays $21.5M to End FCA Suit

Medicare is a national social insurance program that provides health insurance to Americans who are aged 65 or older, younger people with disabilities, and people with end-stage renal disease and amyotrophic lateral sclerosis. As a social insurance program, it is largely funded by payroll taxes on employers and workers, and accounts for about 17% of the 2016 proposed Federal budget. The program contracts with regional insurance companies to process fee-for-service claims per year in order to provide health insurance options for eligible Medicare patients.