Takeaway: The H.I.G. case will no doubt embolden the Department of Justice and whistleblowers going forward. Now DOJ and relators have a strong summary judgment opinion to ground liability in future cases and several sizeable recoveries against PE firms to use as comparators for settlement purposes.
Takeaway: 2021 has been a record year for the SEC’s whistleblower program with awards for fiscal year 2021 topping $500 million and total awards now exceeding $1 billion. This reflects both a pro-whistleblower administration and a growing private-public partnership in exposing corporate malfeasance.
Takeaway: Based on data reported by the State Attorney General, New Jersey’s False Claims Act (NJFCA) has been a legislative success. Between 2010 and 2019, the State netted $147 million under the NJFCA, while relators received $8.8 million.
Takeaway: This recovery makes it very clear that the federal government and whistleblowers continue to aggressively pursue fraud allegations involving the Medicare Advantage Program. We can expect to see robust enforcement and sizable recoveries to continue.
On August 30, 2021, the United States Department of Justice announced a $90 million settlement with Sutter Health and certain of its affiliates (collectively Sutter Health) relating to allegations that Sutter Health had defrauded the federal government’s huge Medicare Advantage (Part C) Program.
- Individuals should be wary of the Speaker Programs they choose to attend. Simply attending a Speaker Program where alcohol or an expensive meal is served can be viewed as remuneration in violation of the AKS.
- HCPs should be extremely selective of the Speaker Programs they choose to participate in.
- The District of Massachusetts issued the very first summary judgment decision in a False Claims Act (FCA) lawsuit involving a private equity (PE) firm. The decision provides valuable insight into how the FCA may apply to PE firms.
The Fourth Circuit Joins Other Circuits in Adopting the “One Purpose Test” while Upholding a $114M Jury Verdict
The Fourth Circuit becomes the most recent Circuit Court to adopt the test for the Anti-Kickback Statute 42 U.S.C. § 1320a-7b(b) “that at least one purpose of the remuneration was to induce the referral of services, rather than the primary purpose of the remuneration.” United States v.
2020 False Claims Act Recoveries: $2.2 Billion in Recoveries and Over $309M in Awards to Whistleblowers
- Over $300 million awarded to whistleblowers.
- Dip in recoveries reflects pandemic and economic challenges.
- Number of FCA filings hits a record.
- Healthcare continues to dominate FCA recoveries with kickbacks a major focus.
- Rebound in recoveries is likely as defendants regain financial footing.
On April 16, 2020, the Honorable William M. McSwain, United States Attorney for the Eastern District of Pennsylvania, issued a sweeping request for help in identifying companies and individuals who seek to “exploit the devastating effects of the coronavirus pandemic for their own benefit.” The Philadelphia United States Attorney’s Office has a long history fighting fraud.
While most compliance programs tout policies and procedures encouraging employees and contractors to internally report their concerns, the reality is that many businesses are unprepared to respond appropriately when they receive a complaint from a whistleblower. This lack of preparation often stems from a critical failure to understand the whistleblower’s concerns and to train frontline managers and compliance professionals on how to speak with internal whistleblowers.