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Healthcare and the False Claims Act, 2016 Survey summarizes the important laws, regulations, pronouncements, and cases of the past year, to inform healthcare providers and healthcare attorneys on this crucial statute in the healthcare industry.
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 2012, the Department of Justice announced that $3 billion of the $5 billion recovered under the FCA was health-related. 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 2014 Cumulative SupplementThis 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 FCAWhat 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 ACTIONSWhen 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 DAMAGESHow 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 LIMITATIONSHow do courts compute the FCA statute of limitations?VOLUNTARY DISCLOSURES TO THE OIGUnder 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 PROVISIONWhat does a retaliated against "whistleblower" need to prove to obtain damages from the employer?The eBook versions of this title feature links to Lexis Advance for further legal research options.
UPDATED IN MARCH 2013 to include the historic $104-million Bradley Birkenfeld whistleblower case and more! From the nation’s leading whistleblower attorney, comes the third edition of the first-ever consumer guide to whistleblowing. In The Whistleblower’s Handbook, Stephen Martin Kohn explains nearly all federal and state laws regarding whistleblowing. In the step-by-step bulk of the book, he also presents twenty-one rules for whistleblowers.
This book covers the merits of a potential action; determining whether the relator would be barred or restricted from any recovery for retaliation and more.
When John Schilling, an unassuming midlevel accountant, joined Columbia Healthcare Corporation -- the nation's fastest growing and revolutionary network of public hospitals -- it seemed like the start of an exciting new career with great advancement and earnings potential. He never expected to become a catalyst for the series of "whistleblower" lawsuits that ripped through the healthcare industry in the late 1990s In Undercover, John Schilling tells the story of his harrowing journey from ordinary citizen and loyal employee to covert FBI informant and top witness for the Justice Department in the largest criminal healthcare fraud case in U.S. history. It began when he stumbled upon evidence-- a $3.5 million accounting "error"--of his company's routine practice of defrauding Medicare. When pressured to comply with stealing from taxpayers, Schilling knew he had to speak up for what he believed was right, regardless of the cost to his job, his reputation, and his family. His courageous choice would consume the next seven years of his life, leading to more drama, angst, turmoil, and money than he could have imagined. Ultimately, Schilling's moral conviction and a little known law, the False Claims Act, paid off by forcing the formidable healthcare conglomerate of Columbia/HCA to pay back $1.7 billion to the federal government. Revealing the personal side of a thankless role, Undercover is a gripping and inspiring account of a long, hard, life-- changing quest for justice. ADVANCE PRAISE FOR UNDERCOVER "Undercover crackles with authenticity as it recounts in a lively, readable style how a man on the inside risked everything and blew the whistle on a giant healthcare company that was systematically looting the Medicare program out of billions. A good read for anyone, but a must-read for someone who may contemplate taking the same path as John Schilling" -- John R. Phillips, "The nation's premier whistleblowing attorney" according to the The Wall Street Journal and the National Law Journal "John Schilling's book is a must-read for whistleblowers. He shows you how hard it can be, yet also shows you how to prevail. Best of all, John shows you how to be a good citizen" -- Jim Moorman, past President, Taxpayers Against Fraud