APPLICATION OF THE FALSE CLAIMS ACT
Meaning of specific terms under the FCA materiality; conspiracy; reverse false claims.
QUI TAM PROVISIONS
Actions by private parties; rights of the parties in qui tam actions; award to qui tam plaintiffs; Section 3730(e) jurisdictional bar; expenses and fees for which the government is responsible; whistleblower retaliation provision; discovery in relator-only lawsuits.
DAMAGES AND CIVIL PENALTIES
Legislative amendments; principles and proof of FCA damages; practice areas raising damage issues; constitutional limitations on civil penalties.
FALSE CLAIMS ACT PROCEDURE AND JURISDICTION
Service of subpoena; statute of limitation; burden of proof.
CIVIL INVESTIGATIVE DEMANDS
As administrative subpoena; responding to the CID.
THE VOLUNTARY DISCLOSURE PROGRAM
Submitting a voluntary disclosure; operation of the Inspector General's voluntary disclosure program; benefits and risks associated with voluntary disclosures; settling the matter.
TABLE OF CASES
If you are not an AHLA member and would like to purchase this title, click here. Significant events have occurred regarding the government's enforcement and administration of the False Claims Act (FCA) in the last few years. The government has continued to negotiate major settlements against healthcare entities. And the courts have issued numerous decisions that impact the manner in which healthcare businesses are organized and operated. In November 2011, the Department of Justice announced that since the FCA was substantially amended in 1986, it had recovered more than $30 billion under the FCA, and in 2011, it recovered $3 billion, of which $2.4 billion was from health-related FCA cases. With these recent developments in FCA litigation and the rapidly developing case law, you will need the Second Edition of False Claims Act & the Healthcare Industry and the 2012 Cumulative Supplement (For information on or to purchase this Supplement, click here.) This authoritative treatise will keep you up-to-date on the latest FCA developments so that you can more effectively advise your client on how to assess their company's potential exposure to liability, evaluate the exposure of companies that they may acquire, and reform company practices to reduce the risk of potential FCA liability. EXPERT ANALYSIS: THE ELEMENTS THAT CREATE LIABILITY UNDER THE FCA
• What does it mean to "Present or Cause to Present" a false claim?
• How do courts determine whether a claim is "False or Fraudulent"?
• How does one "know" under the FCA, that a claim is "False"?
• When is a claim "Material" to the government's determination to pay? LEADING DEFENSES THAT RESULT IN THE DISMISSAL OF QUI TAM ACTIONS
• When are lawsuits barred under the FCA public disclosure bar?
• What must the whistleblower prove to show that she qualifies as an "original source"?
• Under what circumstances do courts dismiss actions for failure to state fraud with specificity under Fed.R.Civ.P.9(b)?
• Under what circumstances does a plaintiff fail to show that defendant submitted a "false" claim or statement under the FCA?
• Under what circumstances does a plaintiff fail to establish that the defendant "knew" that a claim wa false or fraudulent? FCA DAMAGES
• How do courts compute FCA damages in Healthcare upcoding cases and in cases alleging a violation of the FCA because of a violation of the Anti-Kickback or Stark Law?
• What are the limits courts may impose on the government's or whistleblower's ability to recover FCA damages? FCA STATUTE OF LIMITATIONS
• How do courts compute the FCA statute of limitations? VOLUNTARY DISCLOSURES TO THE OIG
• Under what circumstances should a company consider submitting a voluntary disclosure?
• What is the process underlying the submission of a voluntary disclosure?
• What are the potential benefits and risks associated with submitting a voluntary disclosure? THE FCA WHISTLEBLOWER RETALIATION PROVISION
• What does a retaliated against "whistleblower" need to prove to obtain damages from the employer?
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