March 19, 2019 | New York Law Journal
Claim Certifying Medical Necessity Must Meet Definition of 'Reasonable and Necessary'In this Federal Civil Enforcement column, Richard Strassberg, Annie Railton and Roger Cohen discuss 'United States ex rel. Polukoff v. St. Mark's Hospital et al.', in which the Tenth Circuit held that a claim certifying that a procedure is medically necessary must meet the definition of “reasonable and necessary” set forth in CMS's Medicare Program Integrity Manual.
By Richard Strassberg, Annie Railton and Roger Cohen
8 minute read
September 27, 2018 | New York Law Journal
Circuit Rulings on Civil Investigative Demands Show Agency Deference Is Not UnconditionalIn their Federal Civil Enforcement column, Richard Strassberg, William Harrington and Lauren Bowman discuss two rulings which demonstrate that a boilerplate CID recitation that it is being issued to investigate potential violations of law, without specific details about the nature of that investigation, may present a basis to challenge the enforcement of that CID.
By Richard Strassberg, William Harrington and Lauren Bowman
9 minute read
June 28, 2018 | New York Law Journal
Two Recent Cases Illustrate Need to Rely on Causal Concepts in FCA CasesIn their Federal Civil Enforcement column, Richard Strassberg, William Harrington and Annie E. Railton write: In 2010, Congress amended the anti-kickback statute (AKS) to confirm that claims “resulting from” illegal kickbacks are false and thus actionable under the federal False Claims Act (FCA).
By Richard Strassberg, William Harrington and Annie E. Railton
1 minute read
February 22, 2018 | New York Law Journal
DOJ Gives Mixed Messages on False Claims Act EnforcementIn their Federal Civil Enforcement column, Richard Strassberg and William Harrington write: The DOJ's mixed messages on False Claims Act enforcement, reflect tension in the government ranks over proper deterrence and over-deterrence. This creates defense opportunities for companies and their lawyers caught in civil investigations.
By Richard Strassberg and William Harrington
10 minute read
June 30, 2017 | New York Law Journal
Fraud and Abuse Enforcement Goes High TechIn their Federal Civil Enforcement column, Richard Strassberg and William Harrington write: The eClinicalWorks settlement and OIG report will likely prompt a significant increase in enforcement activity related to electronic health records incentive payments. The authors review these developments, their ramifications, and steps EHR companies and health care providers can take to protect themselves from liability related to EHR incentive payments below.
By Richard Strassberg and William Harrington
20 minute read
February 23, 2017 | New York Law Journal
Under Sessions-Led Justice Department, FCA Enforcement Likely to Continue ApaceIn their Federal Civil Enforcement column, Richard Strassberg and William Harrington write that False Claims Act enforcement has increased dramatically under every president since Ronald Reagan. Practitioners have nevertheless wondered whether we can expect a similarly robust FCA agenda from President Donald Trump. The recent confirmation of Sen. Jefferson Beauregard Sessions III as attorney general and nomination of Rod J. Rosenstein, the U.S. Attorney for the District of Maryland, for deputy AG may suggest a comparably aggressive approach to FCA enforcement.
By Richard Strassberg and William Harrington
19 minute read
November 10, 2016 | New York Law Journal
False Claims Act Round Up: Attacking Claims Post-'Escobar'Federal Civil Enforcement columnists Richard Strassberg and William Harrington write that court decisions in the last six months provide several new grounds for defendants to challenge the viability of False Claims Act suits. These include a potential strengthening of the FCA materiality requirement, the need for particularity in describing why a claim was objectively false, and greater scrutiny of statistical sampling evidence.
By Richard Strassberg and William Harrington
20 minute read
July 05, 2016 | New York Law Journal
Supreme Court Limits Scope of Asset ForfeitureIn their Federal Civil Enforcement column, Richard Strassberg and William Harrington of Goodwin Procter analyze the U.S. Supreme Court's decision in 'Luis v. United States', which shed light on the limits to the, at times, seemingly limitless breadth of the forfeiture laws, but raises a series of questions with which courts will now have to grapple.
By Richard Strassberg and William Harrington
22 minute read
February 26, 2016 | New York Law Journal
Supreme Court to Review Theory of Implied False Claims Act LiabilityIn their Federal Civil Enforcement column, Richard Strassberg and William Harrington write that the False Claims Act has created a powerful incentive to ensure that private parties that enter into contracts with the government deliver the goods or services they promised to provide, but more troubling to some has been the effort to infer that the government contracts include promises to comply with additional requirements, even when no such promises were expressed, and use the FCA to police these broader sets of implied legal obligations.
By Richard Strassberg and William Harrington
11 minute read
November 25, 2015 | New York Law Journal
Turning an Exacting Eye to Physician-Hospital CompensationIn their Federal Civil Enforcement column, Richard Strassberg and William Harrington write that in June 2015, the Department of Health and Human Services issued an "alert" about its concern that hospitals are overcompensating doctors in order to pay illegal kickbacks for patient referrals, and has since brought a number of cases that provide a guide to the key areas of concern for hospitals and physicians.
By Richard Strassberg and William Harrington
11 minute read
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