False Claims Act

In past articles, this Blog has written about qui tam actions under the federal False Claims Act (“FCA”). Typically, the whistleblower (known as the “relator”) adds a claim under the state analogue to the FCA. In today’s article, this Blog examines a claim under New York’s qui tam statute. State of N.Y. ex rel. Edelweiss Fund, LLC v. JPMorgan Chase & Co. , 2020 N.Y. Slip Op. 50380(U) (Sup. Ct., N.Y. County (Mar. 27, 2020) ( here ). Background Edelweiss involved a claim und

In today’s business environment, it is not uncommon for departing employees to sign a separation or severance agreement that includes a bar from bringing “any and all” claims related to their employment. The enforceability of such pre-filing releases has frequently been the basis for motions to dismiss by defendant companies in actions arising under the False Claims Act (“FCA”). The FCA is silent on the issue. Last month, a district court judge sitting in the United States D

Goldman Sachs Group, Inc. (“Goldman Sachs” or the “Company”) is requesting that wrongful termination claims brought by a former executive alleging whistleblower retaliation by the Company should be heard in arbitration or dismissed all together. In early August, former Goldman Sachs executive, Chris Rollins (“Rollins”), brought suit against the Company, asserting that its leaders wrongfully blamed him for failures with the Company’s anti-money laundering procedures, ruined h

On May 30, 2018, Minnesota became the most recent state to join the list of states filing lawsuits in whistleblower litigation against Arizona-based Insys Therapeutics, Inc. ("Insys") ( INSY.O ): Arizona, New Jersey, New York, and North Carolina. Previous cases have been settled by Oregon, New Hampshire, Illinois, and New Hampshire for $9.45 million. The Minnesota action, which was filed in Hennepin County District Court in Minneapolis, comes as state attorneys general are

On May 8, 2018, the U.S. Government Accountability Office (GAO) issued recommendations for the purpose of increasing the effectiveness of paying whistleblowers to report illegal wildlife trafficking. Wildlife trafficking, one of the top-ranked illegal trades in the world, accounts for approximately $23 billion a year, with the United States as one of the greatest contributors. Animal Trafficking and the Push for Accountability According to the GAO report ( here ), trafficking

Last November, this Blog wrote about an announcement Michael D. Granston (“Granston”), Director of the DOJ Commercial Litigation Branch, Fraud Section, made at a health care conference concerning the DOJ’s intention to seek dismissal of meritless qui tam cases. ( Here .) Since the speech was not accompanied by a policy memorandum, there was skepticism within the False Claims Act (“FCA”) bar that there would be any material change in policy. That skepticism was met last month

What facts must you plead to pursue a false claims case? In , the United States Court of Appeals for the Sixth Circuit (Sixth Circuit) reaffirmed the “stringent” pleading requirement for cases brought under the False Claims Act. The pleading standard comes from the Federal Rules of Civil Procedure 9(b) which requires the plaintiffs to plead their case with “particularity.” In , the Sixth Circuit held that the “particularity” standard for litigating complex schemes or fraud u

Following months of hinting that the Department of Justice (“DOJ” or “Department”) would change its qui tam policies, Michael Granston (“Granston”), Director of the Civil Fraud Section, announced that the DOJ will now move to dismiss qui tam actions brought under the False Claims Act when it concludes that the actions lack merit.  The announcement was made during a presentation at the Health Care Compliance Association’s Health Care Enforcement Compliance Institute on Octob

It has been some time since this Blog has written about the False Claims Act (“FCA”). In today’s post, this Blog looks at the Seventh Circuit’s recent embrace of the proximate cause standard for claims arising under the FCA. In United States v. Luce ( here ), the Seventh Circuit overruled its longstanding precedent for alleging causation in cases arising under the FCA. In doing so, the Seventh Circuit joined its sister circuits in holding that the government and whistleblow

On August 8, 2017, the U.S. Department of Justice (“DOJ”) announced a nearly $75 million settlement with PHH Mortgage Corporation (NYSE: Symbol PHH) and PHH Home Loans (collectively, “PHH”) to resolve allegations that PHH violated the False Claims Act by knowingly originating and underwriting mortgage loans insured by the U.S. Department of Housing and Urban Development’s (“HUD”) Federal Housing Administration (“FHA”), guaranteed by the United States Department of Veterans A

Last year, this Blog wrote about a qui tam action that was dismissed by the Sixth Circuit because of the application of the public disclosure bar ( here ). In United States ex rel. Advocates for Basic Legal Equality v. U.S. Bank , 816 F.3d 428 (6th Cir. 2016), the Sixth Circuit held that prior public disclosures are “substantially the same” for purposes of the public disclosure bar if they “encompass” the allegations in the subject qui tam action even though the prior discl

The Department of Justice recently announced a settlement with eClinicalWorks ("ECW" or the "Company") related to alleged False Claims Act violations. The Massachusetts-based company, one of the largest electronic health records ("EHR") vendors in the U.S., had been accused of misrepresenting its software capabilities and paying kickbacks to customers in exchange for promoting its product. What is the False Claims Act? The False Claims Act is designed to protect the governme

In  Universal Health Services, Inc. v. United States ex rel. Escobar , the U.S. Supreme Court unanimously confirmed that the false certification theory “can be a basis for liability” under “some circumstances.” ( See  Blog post here .)  Those circumstances are: (1) the defendant does not merely request payment, but also makes specific representations about the goods or services provided; and (2) the defendant’s failure to disclose noncompliance with material statutory, regula

The Justice Department has joined a whistleblower lawsuit against United Healthcare Group, Inc. ("UHG" or "United") in connection with payments made to the company for its Medicare Advantage Plan. ( Here .) The suit claims the insurer obtained inflated risk-adjusted payments from the Medicare program by providing false and inaccurate information about the health risks of patients enrolled in UHG's largest Medicare Advantage Plan, UHC of California. The original lawsuit was fi

Last month, the Fifth Circuit issued U.S. ex rel Abbott v. BP Exploration and Production, Inc . , --- F.3d ---, 2017 WL 992506 (5th Cir. Mar. 14, 2017), a decision in which it applied the materiality standard set forth by the Supreme Court in Universal Health Services, Inc. v. United States ex rel. Escobar , 136 S. Ct. 1989 (2016) (discussed here ), to dismiss a qui tam action using the implied certification theory as the basis for liability. In doing so, the Fifth Circuit j

Did Wells Fargo retaliate against whistleblowers who complained about sales pressure? In the wake of the sale's scandal last September that led to the ouster of Wells Fargo & Co.'s CEO John Stumpf, the bank's Board of Directors has been conducting an independent investigation to determine if retail bank employees who complained about sales pressure or practices were retaliated against. With an assist by a New York-based law firm, the bank recently released its findings, writ

Medicare and Medicaid fraud costs taxpayers billions of dollars each year.  In 2016, the Government Accountability Office (“GAO”) estimated that in fiscal year 2015, taxpayers lost almost $90 billion to improper payments from Medicare and Medicaid providers.  The GAO defines an improper payment to be any payment that should not have been made or that was made in an incorrect amount (including overpayments and underpayments) under statutory, contractual, administrative, or ot

The Department of Justice ("DOJ") recently announced that CA Technologies ("CA") has agreed to pay $45 million to resolve allegations under the False Claims Act related to a General Services Administration ("GSA") contract awarded to the company for software licenses and maintenance services. CA is an international information technology management software and services company with headquarters on Long Island, New York.  The government alleged that CA made false statements

In a case of first impression for the courts within the Second Circuit, Judge Richard J. Sullivan of the United States District Court for the Southern District of New York answered the foregoing question: no. United States v. L-3 Commc’ns Eotech, Inc. , No. 15-cv-9262 (RJS) (S.D.N.Y. Feb. 3, 2017). An Overview of the False Claims Act and the Whistleblower Reward The False Claims Act (“FCA” or the “Act”) prohibits businesses and individuals from defrauding the government by