On July 7 the Fourth Circuit invoked Flying Pigs to vacate a lower federal court judgment in a Medicaid false claim case, even though neither the lower court nor any of the parties asked it to. The case started in 2007, when the relators filed a qui tam action in Virginia state court against several medical …
When Inside Knowledge Is a Handicap to a Whistleblower
June 27, 2016 Leave a Comment
Here’s a riddle: The whistleblower is a former employee of the defendant, with inside knowledge of the operations at the heart of his qui tam suit. How can that inside knowledge be a handicap in pressing his claim? A June 21 decision by a Massachusetts federal court provides an answer and an …
New Guidance on Exclusion
April 19, 2016 Leave a Comment
For the first time in nearly 20 years the Office of Inspector General (OIG) of the Department of Health & Human Services has issued new guidance on the exercise of its authority to exclude health care providers from participating in federal health care programs, including Medicare, Medicaid, and Tri-Care. …
A Grossly Negligent Claim Isn’t a False Claim
March 16, 2016 Leave a Comment
You have to feel sorry for whistleblower Darilyn Johnson. The former billing clerk thought she had a sure-fire, double-barrel False Claims Act (FCA) case against the medical clinic that fired her. Barrel one was her basic FCA case. Darilyn could prove that when the allergy clinic filled out its Medicare …
The Downside of Being Number One
March 14, 2016 Leave a Comment
Americans are competitive. We generally think there’s nothing better than being number one—and not just at NCAA bracket time. But being number one isn’t always great. Just ask Dr. Michael Reinstein. He was the nation’s number one prescriber of the antipsychotic clozapine. How many prescriptions …
Services that are Worth Less Aren’t Necessarily Worthless
February 25, 2016 Leave a Comment
The Sixth Circuit brought a refreshing sense of reality to the government’s sometimes unreal calculation of damages in False Claims Act (FCA) cases. In this case the government had sought, and won at the trial level, an award of $763,000 against a contractor because of a subcontractor’s underpayment of …