2015 False Claims Act Year in Review: 5 Major Developments Affecting the Health Care Industry

Bloomberg BNA Health Law Reporter

George B. Breen, David E. Matyas, and Daniel C. Fundakowski, attorneys in the Health Care and Life Sciences practice, in the firm’s Washington, DC, office, authored an article in Bloomberg BNA Health Law Reporter titled “2015 False Claims Act Year in Review: 5 Major Developments Affecting the Health Care Industry.”

Following is an excerpt:

The past year was significant for the reverse false claims theory because a federal court issued the first published guidance on when an overpayment is deemed ‘‘identified.’’ … In United States ex rel. Kane v. Health-First, Inc., the relator alleged that, due to a software glitch, three New York City hospitals erroneously billed the New York Medicaid program as a secondary payor after already being paid in full by the patients’ Medicaid managed care plans. After the state comptroller inquired, management tasked the eventual relator with investigating. The employee later emailed management a spreadsheet of over 900 claims believed to be subject to the glitch. While the hospitals refunded the overpayments in full over the next two years, the government and relator alleged that the hospitals had fraudulently delayed repayment by taking two years, rather than the allotted 60 days. The U.S. District Court for the Southern District of New York denied the defendants’ motion to dismiss, holding that the FCA’s statutory 60-day clock for repaying identified overpayments begins ticking ‘‘when a provider is put on notice of a potential overpayment, rather than the moment when an overpayment is conclusively ascertained.’’…