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More than 150 years after the founding of our firm, Sidley today comprises a diverse group of legal professionals from many cultures who are dedicated…
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Sidley Austin LLP | USA | 20 Nov 2019

Ninth Circuit invited to weigh in on public disclosure bar falsity

A US District Court for the Central District of California judge recently granted a stay and certified two questions for interlocutory appeal in a relator's False Claims Act suit. The case involved allegations that one of the defendants had perpetrated an upcoding scheme whereby it trained its doctors to describe medical conditions with language that would support increasing the severity......
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Sidley Austin LLP | USA | 9 Oct 2019

DOJ defends Medicare Advantage upcoding claims against Sutter

The US government recently filed a brief in opposition to Sutter Health's motion to dismiss the Department of Justice's (DOJ's) complaint in intervention in a False Claims Act suit alleging that Sutter had knowingly submitted and caused the submission of unsupported diagnosis codes for Medicare Advantage organisation patients in order to inflate Medicare reimbursement. The brief reinforces......
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Sidley Austin LLP | USA | 18 Sep 2019

Government will allow broader use of co-pay accumulator programmes for 2020

The Department of Health and Human Services (HHS), the Department of Labour and the Treasury have jointly announced that they will not enforce the HHS's recently finalised policy that limits private health plans' use of accumulator programmes to prescription brand drugs for which a medically appropriate generic equivalent is available. Stakeholders should remain alert to any changes in state......
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Sidley Austin LLP | USA | 11 Sep 2019

Medicare Advantage providers pay $5 million to settle False Claims Act allegations

Beaver Medical Group LP and an affiliated physician recently agreed to pay a combined total of $5 million to resolve allegations that providers had knowingly submitted diagnosis codes that were not supported by medical records in order to inflate reimbursements from Medicare. The settlement reflects the Department of Justice's continuing efforts to use its enforcement power to pursue fraud in......
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Sidley Austin LLP | USA | 24 Jul 2019

Sutter Health files motion to dismiss, criticising DOJ's outdated False Claims Act theories in Medicare Advantage case

Sutter Health recently filed a motion to dismiss the Department of Justice's (DOJ's) complaint in intervention in a False Claims Act suit which alleged that Sutter had knowingly submitted and caused the submission of unsupported diagnoses codes for Medicare Advantage patients in order to inflate Medicare reimbursements. Sutter's motion reflects the industry's continued resistance to the DOJ's......
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Sidley Austin LLP | USA | 10 Jul 2019

Lethal injection opinion from DOJ OLC threatens FDA's claims-based interpretation of 'intended use'

In a recent opinion, the Office of Legal Counsel (OLC) in the US Department of Justice concluded that an article intended to effectuate capital punishment by a state or the federal government is not subject to regulation by the Food and Drug Administration (FDA) under the Federal Food, Drug and Cosmetic Act. The OLC's opinion appears to have been issued as a result of litigation involving the......
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Sidley Austin LLP | USA | 24 May 2019

Court permits New York DFS suit against OCC regarding fintech charter

A federal district judge recently denied a motion to dismiss filed by the US Office of the Comptroller of the Currency (OCC) in a lawsuit brought by the New York State Department of Financial Services, which challenged the OCC's decision to begin accepting applications from fintech companies for special purpose national bank charters.
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Sidley Austin LLP | USA | 22 May 2019

Rule 9(b)'s particularity requirement and constitutionality of False Claims Act qui tam provisions

In a recent decision, the Tenth Circuit reversed a district court's dismissal of qui tam claims, reasoning that the relator's allegations had satisfied Rule 9(b) of the Federal Rules of Civil Procedure. Among other things, the defendant contended that the court's intervention is necessary to resolve a deep circuit split on whether Rule 9(b)'s particularity requirement can be relaxed where a......
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Sidley Austin LLP | USA | 1 May 2019

Supreme Court appears poised to extend False Claims Act statute of limitations

The Supreme Court recently heard an oral argument in a case that appears likely to resolve a circuit split on a question of critical importance: in non-intervened False Claims Act cases, are relators entitled to invoke the act's alternative 10-year statute of limitations? Clarification of the circuit split on the availability of the 10-year statute of limitations will have a significant......
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Sidley Austin LLP | USA | 24 Apr 2019

Third Circuit finds individual ownership interest in corporation not required for False Claims Act liability

The Third Circuit recently affirmed and vacated in part a district court ruling granting the United States' motion for summary judgment. The case raised, among other things, the issue of whether an individual without any ownership interests in a company can face False Claims Act liability for the company's failure to perform a required act to qualify for reimbursement and whether an unsworn......
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