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 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.
- January 18, 2021 by Alexander Owens
- Construction, Defense Industry, Federal False Claims Act, Financial Industry, Government Contracts, Healthcare, Investigations, Medicaid, Medicare, Medicare Part D, Pharmaceuticals, Research, State False Claims Acts
- 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.
In the midst of the COVID-19 pandemic, businesses and individuals around the world are rising to the occasion and ordinary people are doing extraordinary things. We have seen first responders, emergency room physicians, nurses, grocery store workers, and mail carriers go above and beyond their call of duty.
The perils of substituting relators in the midst of a qui tam were the highlight of this week’s decision by the Delaware Supreme Court on certification from the Third Circuit Court of Appeals in United States v. Sanofi-Aventis United States Llc, No. 256, 2019, 2020 Del. LEXIS 97 (Mar.
strong appeal in the concept of remaining anonymous for many whistleblowers but
unless you can prove both a fear of severe harm,
and that the fear of severe harm is reasonable, two recent Circuit Court
decisions illustrate how unlikely it is that you can remain in the shadows and
demonstrates the risks inherent to that pursuit.