Berger & Montague, PC

Category: Content
Type: Blog Article

Generated 3 days ago

New blog articles detected

  • The Federal Anti-Kickback Statute

    By Shauna Itri The federal Anti-Kickback Statute, 42 U.S.C. § 1320a-7b(b), (“AKS”) arose out of congressional concern that remuneration provided to those who can influence health care decisions would result in goods and services being provided that are medically unnecessary, of poor quality, or harmful to a vulnerable patient population. To protect the integrity of […] The post The Federal Anti-Ki...

Berger & Montague, PC

Category: Content
Type: Blog Article

Generated 3 days ago

New blog articles detected

  • Meeting the Materiality Requirement of the False Claims Act in Cases Brought by Qui Tam Whistleblowers

    By Daniel Miller The False Claims Act’s Materiality Requirement Under the express language of the False Claims Act (“FCA”), material means having a “natural tendency to influence or be capable of influencing” the government’s decision to pay a claim.  31 U.S.C. § 3729(a)(4). The Escobar Decision Under the recent Supreme Court case of United Health […] The post Meeting the Materiality Requirement o...

Berger & Montague, PC

Category: Content
Type: Blog Article

Generated 3 days ago

New blog articles detected

  • Fraudulent Inducement as a Legal Theory Under the Qui Tam Provisions of the False Claims Act

    By Daniel Miller While many defendants may assert that fraudulent inducement is not a viable theory of liability in a qui tam case under the False Claims Act (“FCA”), the truth is that the plentiful and better-reasoned authorities to consider this issue support FCA liability for defrauding the FDA.  See United States  v. Pfizer, Inc., […] The post Fraudulent Inducement as a Legal Theory Under the ...

Berger & Montague, PC

Category: Content
Type: Blog Article

Generated 1 week ago

New blog articles detected

  • Pleading Standards in the Eighth Circuit

    By Daniel Miller Federal Rule of Civil Procedure Rule 9(b) Relators in qui tam cases under the False Claims Act (“FCA”) face considerable challenges in meeting pleading requirements in many circuits, including the 8th Circuit. The Rule 9(b) standard in the Eighth Circuit is well described by the Court in United States ex rel. Joshi […] The post Pleading Standards in the Eighth Circuit appeared fir...

Berger & Montague, PC

Category: Content
Type: Blog Article

Generated 1 week ago

New blog articles detected

  • False Claims Act Cases Based on Fraudulent Inducement

    By Joy Clairmont Liability under the False Claims Act (“FCA”) for fraud in the inducement is established when eligibility to receive funds under a government program was procured by misstatements or other misleading actions.  Courts have repeatedly held fraudulent inducement is a viable theory of liability under the FCA.  See United States ex rel. Miller […] The post False Claims Act Cases Based o...

Berger & Montague, PC

Category: Content
Type: Blog Article

Generated 2 weeks ago

New blog articles detected

  • Whistleblower Lawsuits Against Medicare Advantage Organizations

    By Susan Thomas In addition to the big qui tam case against UnitedHealth Group that has received so much press recently, there is a similar whistleblower case pending in federal court in Texas alleging False Claims Act (“FCA”) claims against a medical coding company, Censeo Health, L.L.C., and several Medicare Advantage organizations (“MAOs”).   Similar to […] The post Whistleblower Lawsuits Again...

  • Senator Chuck Grassley and Seema Verma Discuss the Importance of the False Claims Act to CMS

    By David Filbert and Daniel Miller  On February 16, 2017, the Senate Finance Committee held a confirmation hearing for Seema Verma to become the nation’s next Administrator of the Centers for Medicare and Medicaid Services (“CMS”).  During her testimony, Senators raised wide-ranging questions about the best ways to maintain the quality of the Medicare and […] The post Senator Chuck Grassley and Se...

Berger & Montague, PC

Category: Content
Type: Blog Article

Generated 3 weeks ago

New blog articles detected

  • Laboratories May be Liable under the False Claims Act for Submitting Claims for Screening Tests to Medicare

    By Russell Paul Laboratory tests are not medically necessary when they do not “determine a disease or illness. . . or medically or surgically manage an illness.” Strand Analytical Labs., LLC v. Burwell, 2015 WL 4603258, at *17 (S.D. Ind. July 30, 2015) (“The plain meaning of the words diagnose and treat do not include […] The post Laboratories May be Liable under the False Claims Act for Submittin...

  • A Laboratory’s Liability for Medically Unnecessary Lab Tests under the False Claims Act, Part II

    By Russell Paul In Part I of this blog series, we discussed when lab tests are considered “reasonable and necessary” under the False Claims Act (“FCA”) and therefore reimbursable by government health insurers such as Medicare and Medicaid, as well as a laboratory’s responsibility for ensuring that lab tests submitted for reimbursement are properly justified […] The post A Laboratory’s Liability fo...

  • A Laboratory’s Liability for Medically Unnecessary Lab Tests under the False Claims Act, Part I

    By Russell Paul This article addresses the liability of a diagnostic testing laboratory under the False Claims Act (“FCA”) for conducting lab tests that are ordered by a doctor and submitting claims for payment to government health insurers, such as Medicare and Medicaid, for those lab tests when those tests are not medically necessary to […] The post A Laboratory’s Liability for Medically Unneces...

Berger & Montague, PC

Category: Content
Type: Blog Article

Generated 1 month ago

New blog articles detected

  • “Medically Necessary” Ambulance Services Under the False Claims Act

    By Shauna Itri A non-intervened False Claims Act case filed against Medstar, an ambulance company, settled for $12.7 million on January 17, 2017.  The qui tam case was filed on October 4, 2013 in the Federal District Court of Massachusetts under the caption United States ex rel. Dale Meehan v. MedStar et als, Civil Action […] The post “Medically Necessary” Ambulance Services Under the False Claims...

  • Can You Sue A Company Under the False Claims Act If You Don’t Have Copies of Claims for Payment?

    By Susan Thomas A common problem for potential whistleblowers trying to start a case under the False Claims Act (“FCA”) is that they do not always have access to individual claims for payment made by the target defendant. Often this results because the employee does not work in the finance or billing division of the […] The post Can You Sue A Company Under the False Claims Act If You Don’t Have Co...

Berger & Montague, PC

Category: Content
Type: Blog Article

Generated 1 month ago

New blog articles detected

  • Using Differences in Geographic Scope to Avoid the First-to-File Rule in False Claims Act Whistleblower Cases

    By Sherrie Savett and Jonathan DeSantis As recounted in our previous blog entry, the federal False Claims Act (“FCA”) contains a first-to-file rule, which provides that “[w]hen a person brings an action under [the False Claims Act] no person other than the Government may intervene or bring a related action based on the facts underlying […] The post Using Differences in Geographic Scope to Avoid th...

  • Piercing The Attorney Client Privilege In Qui Tam Whistleblower Cases Under The False Claims Act

    By Daniel Miller It is well established that the scope and conduct of discovery are well within the sound discretion of the trial court.  Gaul v. Zep Mfg. Co., No. 03-2439, 2004 U.S. Dist. Lexis 1990, at *3 (E.D. Pa. Feb. 5, 2004) (quoting Marroquin-Manriquez v. Immigration and Naturalization Serv., 699 F.2d 129, 134 (3d […] The post Piercing The Attorney Client Privilege In Qui Tam Whistleblower ...

  • Avoiding Application of the False Claims Act’s First to File Bar

    By Sherrie R. Savett and Jonathan Z. DeSantis The False Claims Act’s first-to-file rule provides that “[w]hen a person brings an action under [the False Claims Act], no person other than the Government may intervene or bring a related action based on the facts underlying the pending action.” 31 U.S.C. § 3730(b)(5).  This blog provides […] The post Avoiding Application of the False Claims Act’s Fir...

Berger & Montague, PC

Category: Content
Type: Blog Article

Generated 1 month ago

New blog articles detected

  • The FCA’s Seal Requirement: Important But (Maybe) Not Fatal

    By Jonathan DeSantis On December 6, 2016 in State Farm Fire and Casualty Co. v. United States ex rel. Rigsby,[1] the Supreme Court resolved a circuit split in holding that a violation of the False Claims Act’s (“FCA”) seal requirement does not automatically require dismissal of a relator’s claims.  Still, relators and their counsel should […] The post The FCA’s Seal Requirement: Important But (May...

  • Excellent Opinion in Support of False Claims Act Case for Customs Fraud

    By Susan Thomas The appeals court for the Pennsylvania-New Jersey-Delaware region recently issued an excellent ruling permitting claims of import fraud to proceed.  The ruling addressed several different issues, but this article will focus only on two – finding that sufficient details had been pled based on a credible methodology for alleging that a substantial […] The post Excellent Opinion in Su...

  • Businesses That Misrepresent Their “Special Status” Eligibility for Contract or Grant Preferences Can Be Liable Under the False Claims Act

    By Susan Thomas “The Congress has established a number of statutory goals designed to help small businesses compete for Federal contracts. In addition to the goal of awarding at least 23 percent of all Federal prime contracting dollars to small businesses, the Congress also established Government-wide contracting goals for participation by small businesses that are […] The post Businesses That Mis...

  • The FCA Protects Whistleblowers from Employer Retaliation

    By Jonathan DeSantis and Sherrie Savett Employers frequently retaliate against whistleblower employees through a variety of adverse actions, including termination, demotion, failure to promote, or reassignment to a less desirable position.   Employers will often attempt to justify retaliation by creating an excuse that is unrelated to an employee’s attempts to uncover or report fraud when the […] ...

  • FCA Liability for Medicare Advantage Fraud Part 1: Presentment of False Claims by Medical Providers to Medicare Advantage Organizations

    By Jonathan DeSantis Medicare fraud is one of the prime drivers of litigation under the False Claims Act (“FCA”). Under traditional Medicare, service providers are directly reimbursed with federal government funds. In 2003, Congress significantly expanded the availability of an alternative to traditional Medicare known as Medicare Advantage.  Medicare Advantage differs from traditional Medicare in...

Berger & Montague, PC

Category: Content
Type: Blog Article

Generated 6 months ago

New blog articles detected

  • Background Check Errors FAQs

    When businesses are vetting a new or potential employee, it’s common for them to run a background check on the individual. This can sometimes be anxiety-producing, but it’s important to know that you have rights. The U.S. Equal Employment Opportunity Commission (EEOC) protects applicants and employees from discrimination, and the Fair Credit Reporting Act (FCRA) […] The post Background Check Error...

Berger & Montague, PC

Category: Content
Type: Blog Article

Generated 7 months ago

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