California’s Nursing Homes Place Profits Over Employee and Resident Rights

Tens of thousands of Californians work in the state’s Skilled Nursing Facilities (“SNF”) and Assisted Living Facilities (“RCFE”).  Much of this workforce is underpaid and overworked.  Workers who care for senior citizens are the front line for preventing abuse and neglect.  Sadly, the companies that employ these workers frequently place hard working nursing staff, including Registered Nurses (“RNs”) and Licensed Vocational Nurses (“LVNs”) and Physical and Occupational Therapists in difficult if not impossible situations because they place profits over quality care.  When elder abuse occurs employers are often quick to blame low level staff when the root cause of the abuse is systematic under-staffing and poor training. Read More ›

U.S. Supreme Court Speaks on the False Claims Act

On December 6, 2016, the U.S. Supreme Court, in State Farm Fire & Cas. Co. v. United States ex rel. Rigsby, Docket No. 15-513, slip op. (S.Ct. December 6, 2016) (“State Farm v. Rigsby”), found that failure to keep a False Claims Act (“FCA”) complaint under seal for the required 60 days was not sufficient to warrant a dismissal with prejudice.   Read More ›

Drug Addiction Rehabilitation Scams Profit Off of Addicts and Insurance

As drug addiction in the United States continues to gain national attention, the drug addiction rehabilitation industry booms. The Substance Abuse and Mental Health Services Administration estimates the addiction rehabilitation market is about $35 billion each year. While most of the industry provides life saving services for individuals struggling with addiction, some run scams to profit off of addicts and their insurance policies. Read More ›

Mylan Business Practices Harm Consumers, Insurers and the Government

Mylan NV's EpiPen has made headlines recently, and not in a positive way. Outrage grew in August at a jaw dropping 500% price hike for its EpiPen epinephrine auto injectors. The EpiPen is a lifesaving device used to treat severe allergic reactions, or anaphylaxis. The device is essentially a spring loaded syringe that injects a dose of epinephrine into the thigh, even through clothing.  Read More ›

Compounded Drug Fraud

Drug compounding is the process by which a pharmacist combines or alters ingredients to make medications tailored to individual patient needs. Common examples include putting medication in liquid form for elderly patients or excluding an allergen. Many people benefit from these services.  Read More ›

Seventh Circuit Holds Medicare Part D is Entitled to Lower Prices Offered by Pharmacies to Patients under Discount Programs

The issue of what constitutes a medical provider’s “usual and customary” price has been at the center of a litany of false claims act litigation, at both the state and federal levels.  When dealing with prescription drugs paid for by Medicare Part D, CMS states “where a pharmacy offers a lower price to customers throughout a benefit year” the lower price is considered the “usual and customary” price rather than “a one-time ‘lower cash’ price.” Read More ›

Ninth Circuit Limits Public Disclosure Defense

In federal and California state courts, defendants often look to the “public disclosure bar,” 31 U.S.C. § 3730(e)(4)(A) and Cal. Gov. Code section 12652, subd. (d)(3)(A), to shield them from liability from claims brought under the Federal and California False Claims Acts. Not surprisingly, defendants routinely argue that the public disclosure bar should be broadly construed to bar claims that are only tangentially related to information publicly disclosed before the whistleblower (also called the “relator”) filed their false claims action. Read More ›

Court of Appeal Limits Public Disclosure Defense under the California False Claims Act

Under the California False Claims Act, like its federal counterpart, defendants often seek to have claims against them dismissed on the basis of the “public disclosure” bar, Cal. Gov. Code section 12652, subd. (d)(3)(A). The scope of the California False Claims Act’s public disclosure bar was recently considered by the Second District Court of Appeals, which explained that the bar is intended “to prevent parasitic or opportunistic actions by persons simply taking advantage of public information without contributing to or assisting in the exposure of the fraud.” State ex rel. Bartlett v. Miller (2016) 243 Cal.App.4th 1398, 1407. Read More ›

False Claims Act Prosecutions of Fraudulent Provision of Nursing Home Rehabilitation Continue to Increase

The federal government spent roughly 14% of its overall expenditures on Medicare in 2014. Included in those costs were significant money paid to rehabilitation companies and skilled nursing facilities to provide rehabilitation and care services to seniors. Given the massive amount of money being spent on those services, there is also an increasing amount of fraud, abuse and deception occurring, where dishonest providers are seeking to line their pockets with taxpayer dollars. Read More ›

Senator Grassley Files Supreme Court Brief Advocating Broad Application of False Claims Act

Currently pending before the Supreme Court is an important False Claims Act case, Universal Health Services v. United States ex rel. Escobar. The complaint in the case alleges that Universal Health Services knowingly hired unlicensed, unqualified and unsupervised non-medical professionals to provide mental health services in violation of Massachusetts’ Medicaid rules. The company then billed the state and federal governments as if those services had actually been provided by professionals. The misconduct had tragic consequences. According to the complaint, after seeking mental health services and receiving inadequate care from untrained non-professionals, a seventeen year old girl suffered a fatal seizure and died. When her parents discovered Universal Health Services’ failures, they sued under the False Claims Act. Read More ›